Diets help not only lose weight, but also stay healthy. One of these is diet table No. 5. Who is it intended for? What can you eat and what should you avoid with this diet? Read on.

You will need:

A little history

Therapeutic diets appeared in ancient Greece. But their development began in earnest only at the end of the 19th century. And scientific research and special institutions dealing with therapeutic nutrition appeared only in the 20th century. The USSR was especially successful in this. The Institute of Nutrition was created there. Dietetics was developed as a science. One of the most popular scientists who developed therapeutic diets was Maniul Pevzner.
This therapist created 15 different therapeutic diets that are recommended for use to this day.

Diet No. 5 is an important element in the treatment of diseases of the liver and gall bladder.

This is a system of proper nutrition, which, in combination with medications and a correct lifestyle, can not only improve the patient’s condition, but also completely cure the disease.

Who needs it

The diet is quite strict, but gentle in relation to health. Prescribed to both adults and children. “Sitting” on it is allowed constantly or during exacerbations of diseases:

• Liver.
• Cholecystitis.
• Problems of the gallbladder, bile ducts.
• Liver stones.
• Fatty liver.

This diet is prescribed only by a gastroenterologist. You can also adhere to a similar diet yourself if you are confident in this diagnosis or have chronic diseases. Products that are prohibited increase the production of bile, and this creates additional stress for diseased organs. Sometimes a person sticks to this diet all his life if the disease is very serious.

If you do not adhere to such a diet during a chronic illness, exacerbation, poor health and deterioration of health may occur.

Prohibited Products

This diet is not very restrictive. With the right food combinations, a variety of dishes can be allowed. But the following products are prohibited:

• Fresh bread.
• Cakes, pancakes, pastries, sweets, cream and all products with it.
• Mushrooms.
• Meat decoctions and all liquid dishes based on them.
• All fatty meats and fish.
• Ice cream.
• Seasonings.
• Salo.
• Chocolate.
• Eggs (fried, hard-boiled).
• Sour fruits, acidic vegetables (sorrel, spinach), spicy vegetables.
• Beans, peas, beans.
• Horseradish.
• Marinated, salted, smoked products.
• Offal.
• Ketchups, fast food, mayonnaise. But if it can remain on the list of permitted products.
• Caviar.
• Barley, egg porridge.
• Canned food.

This diet prohibits frying foods. Anything that can be cooked incorrectly, is too fatty, fried, or salty cannot be eaten. You can only stew occasionally. You should also consume salt to a minimum (up to 10 g per day). Products cannot be baked or boiled with animal fat or large amounts of vegetable oils. Drinking coffee, all chilled and cold drinks, soda, and cocoa is prohibited.

What to eat

You should eat several times a day in small portions. It is necessary to adhere to the regime.

• It is allowed to eat stale, yesterday's bread. It can be rye bread, bran bread, you can also eat some biscuits and dry cookies.
• All soups should be made only with vegetable broth or water. Milk soups are allowed. Always eat warm, not hot and not cold.
• You can eat porridges that are liquid, viscous, or mushy porridge. You can eat oatmeal, buckwheat, and rice. Make puddings, casseroles, souffles, pilaf, and pasta from them.
• All lean, dietary meat is allowed to be consumed. From all this you should make meatballs and steamed cutlets.
• The meat needs to be ground, eaten in small pieces, and made into minced meat. Sometimes it is allowed to eat natural sausages.
• You can eat lean fish (hake), boil it, bake it.
• You can eat no more than one egg per day. You can add them to dishes and make protein omelettes. It's soft-boiled.
• You can drink milk or add it to tea. You should eat low-fat cottage cheese, cheese, mild types of cheese, yogurt, natural yoghurt, kefir. From all this it is possible to make casseroles, puddings, and cheesecakes. Use no more than 50 g of butter per day.
• Vegetables can be eaten raw, boiled, stewed, baked without oil. You can eat non-acidic, mild vegetables.
  Fruits and berries should only be eaten sweet. You can make jellies, mousses, and jams from them. You are allowed to eat dried fruits, honey, and a little sugar.
• You should drink dried fruit compote, weak tea, sometimes you can add lemon or sugar, non-acidic juices, tomato juice, water, rose hip decoction.

Gallstone disease is one of those ailments that require drastic changes in lifestyle. The patient must not only give up bad habits and completely eliminate heavy physical activity, but also rebuild his diet, limiting the consumption of some “forbidden” foods.

Diet for gallstone disease is a complete treatment method: it will help reduce acute pain, stop inflammatory processes and stimulate bile secretion. A certain type of nutrition should be prescribed only by a specialist after a comprehensive examination of the patient.

The composition of bile can vary depending on a person’s health status and lifestyle. Oversaturation with elements such as calcium salts, some types of amino acids, low-density lipoproteins, etc., leads to the fact that they precipitate and accumulate, thereby forming dense formations - stones. Stagnation or infection of bile, inflammatory processes, and lipid metabolism disorders can also lead to this.

Stones in the bile ducts or bladder cause serious discomfort in the patient: severe pain in the right side, jaundice, deterioration in general health. Without proper treatment, gallstone disease can lead to complications. An advanced disease cannot be cured with medications and other non-invasive methods; surgical intervention will be required.

Causes of the disease and risk factors

The main reasons for the accumulation of stones in the gallbladder include:

• increased lithogenicity of bile. This property refers to its ability to settle into stones;
• bile stagnation;
• infectious and inflammatory processes.

Which groups of people are most susceptible to such changes? Risk factors include:

• female gender (women are most susceptible to diseases of the bile ducts and bladder);
• increased blood sugar and cholesterol;
• period of pregnancy and lactation;
• a sharp decrease in body weight;
• elderly age;
• prolonged parenteral respiration;
• taking hormonal drugs.

Clinical manifestations

The most important reason for the increase in the number of advanced gallbladder diseases is that patients often ignore side pain and do not seek help from specialists. The following reasons indicate the presence of the disease:

• biliary colic. This presentation presents as acute, but often short-lived, pain in the right flank. It can radiate, subside in places, but then reappear with greater force;
• dull, aching pain in the liver area. It is associated with an increase in the size of this organ due to impaired excretion of bile. May be accompanied by heaviness and bloating;
• nausea, vomiting;
• a sharp increase in temperature.

If at least one of the symptoms listed above is observed, it is better not to risk it and contact a specialist for a comprehensive examination.

Important! If you observe one of the symptoms of the disease, you should not search on the Internet or old notebooks for traditional medicine recipes against gallstones. Do not self-medicate, as this can lead to loss of time that could be spent on effective therapy under the supervision of a specialist, and cause an exacerbation of the disease.

Dietary Risk Factors

General risk factors that can lead to the formation of gallstones have been described above. But there are also dietary ones, that is, those related directly to nutrition. The formation of stones can result from:

• binge eating;
• lack of polyunsaturated fatty acids in the diet. Many people believe that in order to lose weight and get rid of health problems, it is necessary to exclude “fatty” foods (pork, butter and vegetable oils, nuts, avocados, lard, etc.) from the diet. But this is a serious misconception. Without an adequate content of fatty foods in the diet, it is impossible to imagine stable levels of cholesterol and blood sugar, vascular health, and normal weight;
• a large amount of gluten, starch in the diet (pasta, sweet pastries, bread, cereals);
• lack of vitamin A;
• a negligible amount of vegetables in the diet. Vegetables are the best source of fiber. In addition, they fill the stomach well and eliminate the feeling of hunger. It is recommended to arrange your plate so that half of its total contents are vegetables;
• a large amount of refined and deodorized foods in the diet. It is worth giving preference to whole foods (extra virgin oils, farm meat, full-fat dairy products).

Errors in nutrition can lead not only to obesity, but also to serious diseases. This is once again confirmed by gallstone disease.

Basic principles of the diet

As mentioned above, the diet is prescribed only by a specialist after a comprehensive examination of the patient. An individual nutrition plan is selected for him, which depends on the content of important macro- and micronutrients in his body. But there are also universal principles of diet for gallstone disease.

1. Frequent meals. It is advisable to eat 4-5 times a day in small portions. Firstly, with such fractional meals, the patient will never feel hungry, and therefore, overeat. Secondly, each meal is a kind of impetus for the release of bile, which counters its stagnation. Finally, small portions avoid the feeling of heaviness and stomach pain.
2. Large amount of water. At least 2 liters of water per day - this is true even for healthy people. The more water the patient drinks, the weaker the bile concentration becomes. And this prevents the formation of stones.
3. Limiting the consumption of fried foods or completely eliminating them from the diet. It is advisable not to fry, but to boil, bake, or steam. This is much more useful, since dangerous carcinogens are formed during frying in vegetable oil.
4. Avoid foods high in low-density lipoproteins. These include fast food, baked goods, and some semi-finished products.
5. Elimination of fast carbohydrates (porridge, baked goods, some fruits, sugar, etc.) They contribute to an increase in blood sugar and “bad” cholesterol, do not eliminate the feeling of hunger and cause stagnation of secretion.
6. Enriching your diet with fresh vegetables rich in fiber. The benefits of vegetables were discussed a little higher.
7. Consume whole foods that are minimally processed.
8. Consumption of foods that are rich in calcium (fat cottage cheese, cheese, Varenets, kefir, etc.) They help change the environment to a more alkaline side.
9. Limit your consumption of cold foods and drinks, as they can cause stomach discomfort.
10. Exclusion of spicy, highly salty foods, that is, anything that can irritate the gallbladder.

These are the basic rules that even healthy people can follow if they want to protect themselves from illness. But for patients with gallstone disease, these principles are conditions that must be followed and cannot be avoided.

This is interesting! Over the past 15-20 years, nutritionists from all over the world have been actively complaining about fats and calling them the cause of high blood cholesterol levels, thrombosis, obesity and other diseases. Now a large pool of studies is being conducted that prove that healthy polyunsaturated fats, which are found in meat, fish, eggs, dairy products, vegetables, not only do not have a negative effect on human health, but also contribute to weight loss, improved well-being, etc. .

Diet by point

Let's look at the diet on several main points in order to most accurately answer the question of what it is.

Diet

As mentioned above, the patient eats fractionally (4-5 times a day) and in small portions. It is advisable to eat at the same time, to develop a system.

This regimen does not require a reduction in calories. Frequent meals promote more active excretion of bile and prevent constipation. In addition, the risk of overeating and unpleasant bloating is significantly reduced.

Food processing

Food temperature

The food temperature should be optimal and not cause discomfort. It is recommended to exclude very hot or very cold foods.

Salt

Ideally, many doctors recommend stopping salting food completely. Salt promotes fluid retention in the body and the formation of edema. But not everyone can eat bland food every day. That is why it is necessary to introduce some restrictions - no more than 10 g per day.

Water

The minimum volume of water that you need to drink daily is 1.5-2 liters. This amount does not include juices, tea, coffee and other drinks. It is recommended to completely eliminate sugary sodas and some fruit juices in order to reduce blood sugar and stop excessive insulin production.

It is difficult to eat and drink such an amount of water; you can diversify it with a small amount of lemon juice or ginger.

Alcohol

Alcohol is one of the forbidden products that will be discussed below. It should be abandoned even in the absence of illnesses. With gallstone disease, alcoholic drinks can cause colic, bloating and cramps. This, in turn, leads to severe pain and discomfort.

In addition, alcoholic drinks are often served with ice, which can also negatively affect your well-being.

Note! Drinking alcoholic beverages is not the only bad habit that needs to be abandoned if you have gallstone disease. It is strongly recommended to give up tobacco, overeating, and eating late in the day.

“Forbidden” and “allowed”: what you can and cannot eat on a diet

A diet for gallstone disease involves the introduction of quite serious restrictions. Therefore, every patient needs to know the lists of permitted and prohibited products.

This is a basic list of foods that can and cannot be consumed on this diet. Only a specialist will prepare the exact diet for you.

Diet is the main condition for successful treatment

Diet No. 5 - an emergency measure?

Diet No. 5 is a specific eating style that is used during exacerbation of gallstone disease for 5-7 days. Sticking to such a diet for longer is dangerous for your health: serious restrictions in foods can lead to a lack of macro- and micronutrients.

Diet Principles No. 5

Diet No. 5 can really be called an emergency measure, since it is used only in extreme cases: with increased symptoms of gallstone disease, increased pain in the right side, severe nausea and vomiting. The basic principles of this nutrition are the following points:

• fractional reusable meals. The number of meals per day should be increased to 5-6. The serving weight should not exceed 200 grams. This results in a much lower load on the digestive tract;
• eating only warm dishes (30-40 degrees). It is strongly recommended to avoid hot or cold foods and drinks;
• Mostly dishes are served in crushed form. Smoothies, cream soups, purees are made;
• exclusion from the diet of dishes and foods high in low-density lipoproteins - “bad” cholesterol and trans fats;
• periodic fasting days. As a rule, they represent 1-2 days of complete fasting. The patient drinks warm water, herbal teas and decoctions, sometimes broths;
• reducing the amount of salt. It retains water in the body and promotes stagnation of bile. If it is not possible to completely eliminate salt, you can salt ready-made dishes, but not during the process of preparing them.

Important! Diet No. 5 is only a temporary measure, which is intended to dull the symptoms of the disease. If your health worsens, you should not stick to this diet for more than 2-3 weeks - it is better to resort to surgery or serious therapy.

Menu examples

Below are examples of menus that you can use as a guide when planning your diet. But the list of products, dishes and their volume is determined only by a specialist.

1 menu option

2 menu option

3 menu option

Carrot casserole is both healthy and very tasty!

On a note! Olive oil often appears on the menu. It is important to choose high quality, unrefined, non-deodorized olive oil. Only this can normalize blood cholesterol levels and increase vascular tone.

The need to follow a diet

Diet is a system that needs to be followed in a disciplined manner. Any violations in the menu will nullify all efforts. However, if you follow the diet conscientiously, it can seriously improve your health.

The positive consequences of dietary restrictions include:

• stopping the formation of new stones;
• normalization of digestion;
• solving the problem of constipation, nausea and vomiting;
• lowering cholesterol and blood sugar levels;
• dilution and removal of bile;
• activation of the growth of beneficial intestinal microflora;
• weight loss;
• normalization of sleep;
• dullness of pain in the right side, etc.

This explains the need to follow a diet for gallstone disease. If you do not adhere to a therapeutic eating style, this can result in the following consequences:

• ulcer;
• pancreatitis;
• colic and abdominal pain;
• frequent nausea and vomiting;
• formation of new stones, etc.

The role of magnesium

The role of magnesium in the human body cannot be diminished: it normalizes metabolism, increases vascular tone, takes an active part in the transmission of nerve impulses to internal organs, has a positive effect on insulin secretion, etc. It is especially important to monitor the magnesium content in the blood during cholelithiasis.

Foods with the highest magnesium content

You should not overuse these products: for example, many cereals contain large amounts of starch, which can negatively affect blood cholesterol levels and weight gain trends. But it is necessary to include a small amount of buckwheat, almonds or beans.

Video - Diet for cholelithiasis

Inna Lavrenko

Reading time: 5 minutes

A A

Fractional nutrition for calculous cholecystitis should be limited to 250-300 g, caloric intake per day is limited to 2.5 thousand kcal, of which fat should be 80 g, the same amount of proteins, 400 g of carbohydrates. Salt should be no more than 10g per day, clean water should be drunk at least 2 liters. Cooking should also be mostly steamed, but you can bake it in the oven until crusty. Vegetables should be pureed and rich in fiber; you can eat tough meat.

Allowed products for chronic inflammation in the gallbladder

Chronic cholecystitis without an acute stage of inflammation in the gallbladder is treated with a diet that reduces irritating foods to the mucous membranes of the organs. You can eat the following foods:

• vinaigrette and vegetable salad with added oils (unrefined, cold pressed);
• berries, fruits and various vegetables;
• if you have constipation, introducing fresh vegetable salads will help;
• eggs, one per day. Yolks actively stimulate the flow of bile. If you have a bitter taste in your mouth in the morning, you need to make dishes only from proteins.

Prohibited foods for chronic inflammation in the gallbladder

• Citrus fruits and garlic, other products containing essential oils;
• cabbage decoction, broths;
• sorrel or spinach containing oxalic acid;
• puff pastry, rich pastries;
• offal, fatty cuts of meat. The kidneys, brains and liver contain a lot of cholesterol;
• alcohol of any strength;
• honey, sugar, sweets and jam. High-fat milk, sour cream and cream, fermented baked milk.

Cholecystitis is often accompanied by various diseases. In case of exacerbation of this disease, dietary table No. 5A is required. The nearby organs of the gastrointestinal tract, intestines and gastroduodenal system suffer from pathology in the gallbladder through the general innervation and blood supply.

If pancreatitis is present, then diet No. 5P is needed. The treatment table provides for an increase in carbohydrates and fats, proteins up to 120g. This ratio of nutrients stimulates the pancreas. It is forbidden to consume coarse fiber and concentrated broths. Prepared only in the oven or steamed, you can stew or boil foods. Dietary nutrition must be maintained without disturbances for three months.

With gastroduodenitis accompanying inflammation in the gallbladder, nutrition should be based on dietary table No. 1. The diet should be without foods that stimulate bile synthesis, excessively hot or cold foods. It is best to take food in the form of gruel or liquid. It is prohibited to consume all legumes, asparagus and radishes, as well as fruits with skins - currants, grapes, dates or gooseberries. Stringy meat products and poultry skin, bread and baked goods made from whole grain flour are prohibited.

Diet and drug treatment do not always achieve improvement and recovery. In case of frequent and too pronounced exacerbations of cholecystitis with the release of pus, as well as in some types of gallstone disease, it is necessary not to delay surgical intervention.

Cholelithiasis

Gallstone disease (GSD) varies from patient to patient, but is always characterized by viscous bile with an altered chemical composition, as well as an intensive process of stone formation. In addition to treatment with medications, physical therapy and surgery, experts recommend constantly following a diet, which can not only alleviate the condition, but also prevent relapse. There are several stages of the disease, in which nutrition differs.

Chemical stage of cholelithiasis

At this stage, there is a failure in the production of bile by the liver and its release from the gallbladder. The substance increases concentration, accumulates in the gall bladder, becomes viscous and contains many bile acids, cholesterol and phospholipids. If the disease is detected at this stage and there is no treatment, the process of formation of suspensions, flakes, and bile sediment may begin. Without symptoms, this continues for a long time, moving to the second, latent stage.

During the latent stage of the disease, bile stagnates and active stone formation begins. This usually occurs with inflammatory foci on the mucous membranes of the bile organ, thickening of its walls. During instrumental diagnostics, doctors detect “silent” stones. The stage can last for decades without manifestation of stone activity, there are no symptoms, and the patient is unaware of the disease.

Clinical stage of cholelithiasis

The most dangerous stage of gallstone disease is when the stones begin to move through the ducts. This process is accompanied by pain in the right part of the peritoneum in the hypochondrium, and biliary colic may occur. Each patient has an individual course of pathology - from sluggish to acute with frequent relapses. It is important to consider the size of the stones and their location.

How to eat during an exacerbation of cholelithiasis?

In case of exacerbation of cholelithiasis, it is necessary to use dietary table No. 5A. They adhere to its rules for a couple of weeks until the condition stabilizes, after which they switch to diet No. 5. An approximate menu for a day could be as follows:

• breakfast of semolina porridge or steamed protein omelet, tea with the addition of low-fat milk;
• snack - buckwheat with olive oil, steamed meat cutlets, stale white bread, weak tea;
• lunch - vegetarian soup with rice and vegetables, steamed chicken fillet, buckwheat with unrefined butter, dessert in the form of milk jelly;
• dinner - boiled fish and mashed potatoes, tea with low-fat milk;
• Before going to bed, you can drink a glass of kefir.

During an exacerbation, strict adherence to dietary rules may prevent surgery and eliminate or stop the process of stone formation by normalizing the viscosity of bile and its chemical composition.

Chemical. At this stage, the liver produces bile oversaturated with cholesterol, with a reduced content of bile acids and phospholipids (lithogenic bile). At this stage, patients have no clinical symptoms of the disease; the diagnosis is based on the results of a study of duodenal contents during duodenal intubation, in particular gallbladder bile (portion B). When examining bile, violations of its micellar properties are revealed, cholesterol “flakes”, crystals and their precipitates are detected. Gallstones are not detected by cholecystography at this stage. The first stage can last for many years.

Therapeutic and preventive measures at this stage of cholelithiasis include: a general hygienic regime, systematic physical activity, rational split meals, prevention of obesity and dysfunction of the gastrointestinal tract, elimination of bile stagnation. Medication correction of hepatocellular and gall bladder dyscholia is possible.

Meals with diet No. 5 are fractional (5 times a day). Fried foods are excluded, food is served warm, cold foods are excluded. Vegetarian soups (1/2 plate) with vegetables or cereals and milk soup are allowed. Low-fat meats in the form of steamed cutlets, chicken can be given in pieces, but boiled. Low-fat boiled fish, non-sour cottage cheese (preferably homemade), protein omelettes, milk, mild cheeses, butter are allowed. Vegetables are prescribed raw, pureed. Ripe and sweet fruits and dishes made from them are recommended. The bread is only white, dried. Exclude from the diet legumes (peas, lentils, beans), vegetables and herbs rich in essential oils (garlic, onions, radishes, radishes). The daily amount of liquid is adjusted to 2-2.5 liters.

You can give fruit and berry juices, rosehip decoction, mineral water, weak sweet tea with jam or honey, tea with milk, compotes, fruit drinks, etc.

Fried foods are excluded. You can prepare dishes from stewed products, and also baked (after preliminary boiling). The amount of fat in the diet is adjusted to the physiological norm, 1/3 of the fat is given in the form of vegetable oil. Vegetable oil (olive, sunflower, corn) is added to salads, vegetable and cereal side dishes. Eggs are a valuable food product, have an active choleretic effect, and enhance the motor function of the gallbladder. At the same time, the presence of these properties provokes pain in a number of patients when consuming eggs, which forces them to limit their introduction into the diet in such cases.

It is recommended to consume 100-150 g of raw vegetables and fruits (carrots, sauerkraut, celery, unsweetened and non-acidic fruits) 3-4 times a day before meals. The diet should be rich in dietary fiber with the addition of wheat bran (15 g 2 times a day), which often eliminates the lithogenicity of bile and normalizes intestinal motility.

Drug therapy at the first stage of cholelithiasis should be aimed at stimulating the synthesis or secretion of bile acids, as well as suppressing the synthesis or secretion of cholesterol. For these purposes, the following are prescribed: phenobarbital at a dose of 0.2 g/day (0.05 in the morning and afternoon and 0.1 g in the evening) and zixorine - 0.3-0.4 g/day (0.1 in the morning and 0.2--0.3 g in the evening). The course of treatment is from 3-4 to 6-7 weeks. After a course of treatment, the level of total bilirubin and cholesterol in patients decreases, and the spectrum of bile acids normalizes.

To prevent the formation of cholesterol stones, lyobil can be used (0.4-0.6 g 3 times a day after meals for 3-4 weeks).

Second stage of gallstone disease-- latent, asymptomatic, stone-carrying is characterized by the same physico-chemical changes in the composition of bile as in the first stage with the formation of gallstones. However, there are no clear clinical manifestations of the disease at this stage yet. The process of stone formation at this stage is associated with stagnation of bile, damage to the mucous membrane, and inflammation of the gallbladder wall.

The asymptomatic course of cholecystolithiasis can last quite a long time, which is confirmed by the detection of “silent” gallstones during X-ray and ultrasound examination of the gallbladder and biliary tract in a fairly large contingent of individuals. Clinical symptoms appear 5-11 years after the formation of gallstones.

The leading role in the diagnosis of cholelithiasis undoubtedly belongs to x-ray research methods. Ultrasound examination is very informative. With its help, it is possible to determine the size and shape of the gallbladder, the thickness of its wall, the presence of stones in it, their number and size.

Treatment in the latent stage of cholelithiasis involves following a diet, giving preference to vegetarian foods rich in fiber, avoiding physical inactivity and obesity.

Currently, in various countries of the world, extensive experience has been accumulated in the use of the drugs henochol, henofalk, ursofalk for the purpose of chemically dissolving cholesterol (radiotransparent) stones in the gall bladder. Contraindications to the use of these acids are stones with a diameter of more than 2 cm, as well as a non-functioning gallbladder, biliary colic, liver cirrhosis, peptic ulcer, and pregnancy. The daily dose of henochol, henofalk for patients weighing less than 60 kg is 750 mg (250 in the morning and 500 mg in the evening before bed), for patients weighing more than 70 kg - 1000 mg (250 in the morning and 750 mg in the evening before bed). Under the influence of treatment, the lithogenicity of bile decreases, stones usually dissolve after 12 months or more. Most patients tolerate the therapy well. Sometimes, at the beginning of treatment, stool disorder is observed, which usually disappears with a temporary reduction in the daily dose of the drug to 1-2 capsules. Ursofalk is used depending on body weight from 2 to 5 capsules per day for 12 months. There is a combination drug, lithopalk, which is more effective and has almost no side effects.

The most important achievement of recent years is the development and introduction into practice of the so-called shock wave cholelithotripsy - treatment by crushing large stones (up to 3 cm in diameter) into small fragments, cholesterol in composition (the presence of calcium salts is excluded by the cholecystography method), using shock waves. Treatment is carried out under anesthesia. 2 weeks before cholelithotripsy, it is necessary to start therapy with Ursofalk and after the sessions continue taking the drug until the stones are completely dissolved.

Third stage of cholelithiasis-- clinical (calculous cholecystitis). Clinical manifestations of cholelithiasis depend on the location of gallstones, their size, composition and quantity, the activity of inflammation, and the functional state of the biliary system. Gallstones located in the body and at the bottom of it (the “silent” zone) do not give obvious clinical symptoms until they enter the cystic duct. A stone lodged in the neck of the gallbladder obstructs its outlet and thereby causes biliary (hepatic) colic. In the future, obstruction of the cervix may turn out to be temporary; the stone returns to the gallbladder or penetrates the cystic duct and stops there or passes into the common bile duct. If the size of the stone (up to 0.5 cm) allows, it can enter the duodenum and appear in the stool.

The most characteristic symptom of cholelithiasis is an attack of pain in the right hypochondrium - the so-called biliary or hepatic colic. An attack is provoked by fatty foods, spices, smoked foods, hot seasonings, severe physical stress, working in an inclined position, as well as infection and negative emotions. In women, colic sometimes coincides with menstruation or develops after childbirth.

Biliary colic begins suddenly. At the beginning of the attack, the pain is diffuse and covers the entire right hypochondrium, and then concentrates in the area of ​​the gallbladder or in the epigastric region. The pain varies in intensity: from strong, cutting to relatively weak, aching. Sometimes the pain radiates to the lumbar region, to the region of the heart, provoking an attack of angina. A painful attack can last from several minutes to several hours and even days, and the pain either subsides or intensifies again. Increased contractions of the gallbladder contribute to further advancement of the stone; sometimes, after the spasm relaxes, the stone slips back into the “silent” zone - the bottom of the gallbladder. In both cases, the attack ends as suddenly as it began, and the patient's condition improves. If the attack of colic is protracted, then at the end of it jaundice may occur as a result of a prolonged spasm of the common bile duct, usually short-lived (2-3 days) and not reaching great intensity.

Biliary colic is usually accompanied by nausea and repeated vomiting; patients note a feeling of heaviness in the stomach, flatulence, and unstable stools. An increase in body temperature is a fairly reliable sign of an inflammatory reaction that has joined or caused hepatic colic. High temperature (over 38 o C) is often a sign of purulent and destructive cholecystitis.

With cholelithiasis, complications that require surgical intervention quite often develop: stone obstruction of the common bile or hepatic bile duct with the occurrence of jaundice, blockage of the cystic duct with the appearance of hydrocele of the gallbladder, perforation of the gallbladder into the abdominal cavity with the development of bile peritonitis, progressive liver failure and necrosis of the pancreas glands. Against the background of prolonged calculous cholecystitis, gallbladder cancer can develop.

Laparoscopic examination facilitates clarification of the diagnosis and implementation of therapeutic measures. In the acute phase, the gallbladder is enlarged, tense, its wall is infiltrated, dull, with dilated vessels, and in places covered with fibrin. For diagnostic and at the same time therapeutic purposes, a puncture of the gallbladder can be performed under the control of a laparoscope. In this case, you can obtain information about the nature of the inflammatory process in it.

During an attack of biliary colic, patients usually require emergency medical care and hospitalization in the surgical department.

The operation is indicated in all cases when early clinical symptoms of calculous cholecystitis appear (colic, fever, lack of stable remission between attacks). Surgical treatment is advisable even with a mild clinical picture of chronic calculous cholecystitis. In the presence of large (more than 3 cm) stones, which pose a risk of bedsores, and small (5 mm or less) stones due to the possibility of their release into the bile ducts, patients need surgical intervention. Planned surgery should be performed before recurrent attacks, in the absence of complications and concomitant pathology.

The introduction of laparoscopic cholecystectomy into clinical practice is promising. This method saves the patient from a long hospital stay in the postoperative period, as well as from a cosmetic defect - a postoperative scar after cholecystectomy with conventional access.

It is known that removal of the gallbladder for calculous cholecystitis does not relieve patients from metabolic disorders, including hepatocellular dyscholia, the latter persists even after surgery. In most patients, lithogenic bile is determined, which disrupts the digestion and absorption of fat and other lipid substances, reduces the bactericidal properties of bile, leads to microbial contamination of the duodenum, weakening the growth and functioning of normal intestinal microflora.

The number of patients whose pain and dyspeptic disorders remain or recur after removal of the gallbladder is quite large.

The state of stable compensation in patients who have undergone cholecystectomy is achieved by following a diet and using medications.

The diet provides for maximum sparing of the biliary system and reduction of bile secretion, sparing the gastrointestinal tract. Gentle diet No. 5 provides for a reduction in calories, a normal protein content, a significant limitation of fats and foods containing large amounts of cholesterol, and a limitation of easily digestible carbohydrates. 1.5-2 months after surgery, diet No. 5 is recommended, enriched with fiber (wheat bran, carrots, corn, oatmeal, salads, fruit juices, etc.). This diet normalizes the chemical composition of bile.

Along with diet, medications are used in therapy, since in most patients, therapeutic nutrition alone cannot eliminate pain and dyspeptic symptoms, improve the chemical composition of bile and eliminate other signs of the disease.

In therapy, agents are used that normalize the function of the sphincters of the bile ducts and duodenum (nitroglycerin, debridate, nepatofalk, no-shpa), adsorbents of bile acids (remagel, phosphalugel, cholestyramine), reducing inflammation of the mucous membrane (de-nol, vikair, venter, etc. .), suppressing the activity of pathological microbial flora (furazolidone, biseptol, erythromycin, etc.). In case of reactive hepatitis, hepatoprotective agents are prescribed (Essentiale, Planta, Lipamide), and in case of - adequate doses of enzyme preparations (Pancreatin, trienzyme, etc.).

Issues of preventing stone formation in patients who have undergone cholecystectomy are closely related to the problem of obesity. In this regard, along with a hypocaloric diet that ensures weight loss, bile preparations (lyobil, etc.), as well as ursofalk, henofalk, are recommended to normalize the chemical composition of bile.

The issue of using choleretics and cholekinetics in patients after cholecystectomy remains controversial and unresolved. Their purpose should be treated with restraint. A direct indication for the use of these drugs in patients with a removed gallbladder is only the persisting lithogenicity of bile, despite long-term adherence to the dietary regimen.

Conservative treatment of cholelithiasis is aimed at creating conditions for better outflow of bile and reducing the tendency to further stone formation: an active lifestyle, frequent meals with limiting foods containing cholesterol, mineral waters and choleretic drugs are recommended