Gallstone disease is a fairly common disease. Often people, knowing about the presence of calculi in the gall bladder, do not pay due attention to their health.
Usually, such ignoring the pathological process leads to emergency surgery, and sometimes serious complications. To get rid of the disease without surgery, everyone should know what are the first symptoms of gallstones, their treatment and the prevention of relapses.
Gallstone disease: what is it?
The stones formed in the gallbladder and ducts are fairly solid compounds of calcium salts, bile pigment bilirubin or cholesterol. ZhKB is more common in overweight women, the peak of the disease occurs at the age of 70 years.
A high percentage of the disease in the elderly is due to physiological reasons: with age, the process of bile formation slows down, and the contractile function of the gallbladder becomes insufficient.
However, sometimes stones in the ducts of the gallbladder are diagnosed in children, even in newborns.
Causes of gallstones
Gallstone disease can be called an indicator of lifestyle. It is human habits (eating habits, motor mode), due to the modern realities of life, that lead to the development of cholelithiasis. A high percentage of incidence is recorded in developed countries.
Factors that provoke stones in the ducts of the gallbladder:
- nutritional errors - snacks, overeating, grueling diets and starvation, high-calorie menus (fats, proteins predominate) with insufficient fiber;
- lack of motor activity, sedentary work;
- regular hypothermia, living in a cold climate;
- liver pathology - biliary duct dyskinesia, cholecystitis, impaired liver function (cirrhosis, hepatitis, liver cysts, toxic effects, side effects of cyclosporin, Octreotide, etc.) with a decrease in bile acid production and an increase in cholesterol in bile;
- obesity;
- childbirth (especially in women with many children);
- prolonged use of estrogen-containing tablet contraceptives;
- hereditary predisposition to liver disease;
- other diseases - diabetes mellitus, severe allergies, hemolytic anemia, Crohn's disease, duodenal diverticula.
The mechanism of development of cholelithiasis
The forerunner of cholelithiasis is always the thickening of bile, the formation of biliary sludge and, as a rule, a decrease in the contractility of the gallbladder.
Putty-like bile gradually compacts, turning first into small stones (sand), and only then very dense structures form, which increase in diameter over time.
When exposed to any annoying moment (feast, riding with shaking, etc.), the stones can begin to move and sometimes clog the bile duct lumen, provoking an acute clinical picture.
Types of Gallstones
According to the type of formation, gallstones are divided into:
- primary - the process of stone formation is triggered by a violation of the composition of bile;
- secondary - stones are formed due to cholestasis and the subsequent inflammatory process.
In composition, gallstones are:
- cholesterol - up to 80% of all dense structures in the gallbladder;
- pigmented (bilirubin) - are often the result of hemolytic anemia;
- calcareous - due to secondary calcification of pigment and cholesterol inclusions, less often primary hypercalcemia.
Symptoms of gallstones
Small gallstones usually form without symptoms. Only when their size or quantity reaches sufficient size do pronounced symptoms of the disease appear.
Large, multiple calculi press on the walls of the gallbladder, causing pain and an inflammatory reaction. At the same time, an acute condition may arise at any time, requiring emergency medical attention.
If a small stone passes the bile ducts, colic passes, the condition improves, and the stone comes out with feces. Often large stones get stuck in the bile ducts and, completely blocking their lumen, provoke the development of cholecystitis and jaundice.
Signs that help to suspect gallstones are:
- heaviness in the right hypochondrium;
- belching with a rotten egg, nausea;
- passing pains, especially after a plentiful feast, physical activity;
- bitterness in the mouth.
Such mild symptoms of cholelithiasis can last up to 5-10 years. The only sign of a low-symptom course of the disease can be yellowness of the skin and eyeballs.
Often there is calculous cholecystitis, manifested:
- high fever;
- bad taste in the mouth;
- lack of appetite;
- weakness.
Sooner or later, the stones begin to move along the biliary tract and occurs:
- cutting pain radiating to the lower back, right forearm and shoulder blade, sometimes behind the sternum (simulation of an attack of angina pectoris);
- nausea, vomiting without relief;
- flatulence and belching with air.
Most patients note a clear relationship between the onset of an attack and the effect of a colic factor.
Diagnosis of the disease
Often, stones in the ducts of the gallbladder are detected by chance during an ultrasound or X-ray. According to the research results, a qualified specialist will determine not only the size of calculi and the presence of inflammation, but also determine the approximate composition of stones, assess the risk of developing biliary colic.
For more information about the disease, the following can be prescribed:
- blood tests (general and biochemistry);
- cholecystocholangiography;
- CT,
- retrograde cholangio-roentgenography (during the endoscopic procedure, the doctor can remove small stones).
Treatment of gallstones without surgery
Therapeutic tactics - conservative or radical - are selected only on the basis of diagnostic data. Even in the absence of severe symptoms, an operation to remove stones from the gallbladder can be prescribed.
Surgical treatment is necessary with the development of persistent cholestasis (obstructive jaundice), non-stopable medication or often recurring biliary colic, large sizes of stones, recurrent cholecystitis.
Conservative therapy is advisable for stones with an aggregate (total) diameter of less than 2 cm, good contractility of the biliary tract (not less than 75%).
Non-surgical treatment includes the following measures:
Diet number 5 (Pevzner)
Transition to plant foods and dairy products. Especially useful vegetables (pumpkin, carrots), cereals (hercules, buckwheat) watermelon, apples, wheat bran. Diet with stones in the gallbladder eliminates fatty, spicy, fried.
Chocolate, alcohol, seasonings, coffee / cocoa, pork / lamb, cucumbers, eggplant, legumes, smoked foods are prohibited. Protein is replenished by eating lean meat and fish. Eating in divided portions up to 6 times a day.
Symptomatic treatment
Antispasmodics (Papaverine, No-Shpa), analgesics (Baralgin, Spazmalgon), antibiotics (Clarithromycin, etc.) are used for cholecystitis.
Drug dissolution of stones
Widely used drugs with chenodeoxycholic and ursodeoxycholic acids. Such treatment is advisable only with a stone diameter of up to 2 cm. The course is up to 1.5 years.
Stones that are very dense in structure often do not respond to drug exposure. The effectiveness of manipulation ranges from 40 to 80%, relapse occurs in 2/3 of patients.
Shock Wave Lithotripsy
Lithotrapsy procedure - one of the methods of non-surgical treatment of gallstones, photo
The painless crushing of stones in the gallbladder with the help of ultrasound helps to destroy stones up to 3 cm (no more than 3 pieces!), The fragments of which freely leave the gallbladder.
The procedure is outpatient. The course is 1-7 sessions.
Surgery for cholelithiasis
Surgical treatment is carried out in two ways:
- classic - open cholecystectomy - removal of the gallbladder through a wide incision;
- laparoscopic - cholecystectomy is performed through punctures of the abdominal wall, the operation is mini-traumatic, and recovery takes up to 5 days.
The patient should be aware of the postcholecystectomy syndrome: after cholecystectomy, soreness in the right hypochondrium, a metallic taste in the mouth and bitterness often arise.
Possible complications
- Cholecystitis.
- The formation of adhesions in the gallbladder.
- Pathology of the duodenum after cholecystectomy and frequent enteritis (due to the continuous flow of bile).
- Complicated cholestasis biliary colic.
Relapse prevention
If a person starts the pathological process of stone formation in the gall bladder, it is quite difficult to completely stop it without surgery.
After a mandatory course of treatment, the patient should undergo a routine examination regularly. Even after surgery, the patient is prescribed courses of litholytic drugs.
An important point is the correction of lifestyle, especially nutrition.
Overweight control often helps minimize the risk of re-stone formation and significantly reduces the frequency of relapses.
Gall bladder stones, ICD code 10
In the international classification of diseases, cholelithiasis is located:
Class XI. Digestive Diseases (K00-K93)
K80-K87 - Diseases of the gallbladder, biliary tract and pancreas
- K80 - Gallstone disease
Today, gallstones are found not only in the elderly, but also in young people and even children. If you detect symptoms of gallstones, you should start treatment without surgery, follow a diet.
Treatment without surgery is the only gentle method to eliminate this unpleasant ailment, since any surgical intervention for the body is a lot of stress and requires a rehabilitation period. It is important to know what symptoms appear with stones in the gallbladder in order to start treatment without surgery and switch to a special health diet.
Read about how it manifests itself in the female body.
Symptoms that signal gallstones
In order not to make a mistake with the treatment, you need to be able to correctly identify the disease. After all, the human body is very cleverly designed, and when it fails, it certainly gives a signal about it. All that remains is to correctly “decrypt” this signal.
The most obvious symptoms with gallstones are:
* Periodically, a person suffers from bloating. As a rule, this symptom is most often found in people aged. If bloating occurs after each meal, then gallstone disease is already progressing.
* The appearance of an unpleasant, bitter belching after eating.
* Dull abdominal pain, colic. These symptoms can worsen with the use of fatty and spicy foods. Severe bouts of pain can be accompanied by nausea and vomiting.
* In the presence of stones in the gall bladder, pain can be given to the back, clavicle and arms.
If you find in yourself the above symptom, you should immediately consult a doctor who will help to correctly establish the diagnosis. Often, the pain becomes so strong that surgery is needed. To alleviate the pain of gallstones, a diet should be observed and treatment should begin as soon as possible without surgery.
How to treat gallstones without surgery
Treatment for stones in the gallbladder can be effective only if the person has passed all the tests, underwent a complete examination and accurately ascertained his diagnosis. If the stones in the gallbladder are still small, then they can be dissolved by taking medications prescribed by your doctor, which are very numerous today.
For the most part, these drugs are very powerful, so you can’t take them without the advice of a doctor. It is also necessary to strictly observe the dosage and follow the prescribed course of treatment, in order to avoid overdose and complications on other organs.
Still, the traditional methods of treatment, which cannot be carried out without the supervision of a doctor, include the dissolution of stones with acids, usually it lasts about 2 years. But, after such a course of treatment, relapses are often found.
Other methods include extracorporeal lithotripsy. Using special shock waves, stones are crushed. Data proderu spend if the stones have not yet reached the size of 3 centimeters and there are no contraindications, such as gastrointestinal tract diseases, heart disease.
ethnoscience
Traditional medicine also has a couple of options for how to treat the symptoms of gallstones without surgery, in compliance with the diet. You can deal with this treatment at home, as it is harmless. Recipes of traditional medicine are aimed at gradually dissolving existing stones in the gallbladder painlessly.
Firstly, during the treatment period it is necessary to refuse fatty foods, and after each meal, drink half a cup of warm water with lemon juice (squeeze the juice from one lemon for half a cup). So that as a result of such treatment the stomach does not suffer, it is better to limit yourself to two servings of the drink per day.
Another option that traditional medicine offers is a drink made from honey and fresh onion juice. This "potion" does not harm the stomach and other organs, therefore it favorably affects the entire body. In equal doses, honey and onion juice should be mixed.
This mixture is taken one tablespoon three times a day before meals. This treatment is especially effective if the stones in the gallbladder are small. It will take about 30 days to dissolve them using this method.
To cope with cholelithiasis, ordinary freshly squeezed carrot juice helps. Two glasses of juice should be consumed per day. However, it is worth considering that with excessive consumption of carrots, the skin color may acquire a yellow tint, although there is a lot in the drink.
Dieting
In order not to aggravate the situation of the owl, and to make treatment without stone surgery in the gallbladder more effective, eliminate all symptoms of the disease, you should adhere to a special diet.
The diet is prescribed by a doctor, taking into account all the individual characteristics of the patient. However, there are general principles of the diet for gallstone disease, which all patients should take a closer look at:
* All fatty, salty, spicy foods should be excluded from your diet;
* Excluded from the diet and alcohol, and strong coffee;
* It is not recommended to eat large portions of food at a time. It is better to eat once an hour, eating any fruit or vegetable salad;
* Drink as much fluid as possible. Freshly squeezed juices (and only such juices), non-carbonated drinking water, chicken broth, tea with lemon.
Notice how the masks help.
If you discover the symptoms of gallstones in time, and begin treatment without surgery, go on a health diet, then the disease is not so scary and will not cause complications. To surely find out if there are stones in the gall bladder, you need to undergo an examination and consult a doctor for help, only in this way you can completely protect yourself and your health.
In this article we will try to deal with the causes of gallstones, the first symptoms, risk factors and the possibility of treatment without surgery. We will also touch on the topic of nutrition and try to draw conclusions regarding the operation.
How do gallstones actually arise?
First of all, you need to remember that gallstone disease is a metabolic disorder. This problem appears in people with impaired lipid metabolism and with a violation of cholesterol metabolism. Bile takes part in the breakdown of fats and brings them to a very shallow state. 
If, for example, a person excludes fats from his diet, then the bile will concentrate, which will subsequently lead to the crystallization of stones. The thing is that cholesterol and bilirubin cannot be filtered by the kidneys, so they are excreted exclusively through bile. Under adverse conditions, they are able to settle and form crystals. After that, these crystals begin to turn into real stones, which are dangerous for blocking the ducts. If they form, then you get symptoms that are immediately very difficult to distinguish from other diseases. If the ducts are clogged, then the bile ceases to be excreted, which will inevitably lead to inflammation of the gallbladder.
If you are not sure about the presence of gallstones, then you should go for an ultrasound diagnosis, which will show the exact result.
Symptoms of gallstone disease:
- Pain in the right hypochondrium extending to the neck, arm or jaw
- Nausea and bitterness in the oral cavity
- Constipation, flatulence, loose stools, heartburn
- Yellowing of the skin and eye sclera
These stones are able to reach large sizes (with a quail egg), when the size of the stone reaches a mark of 4-5 mm, then it becomes larger than the size of the duct and the channel becomes clogged.
Large stones cannot be dissolved by therapeutic methods, therefore, in such cases, you need to go to surgery. Most often this results from neglected treatment of one’s health and untimely treatment to a doctor.
What causes the appearance of stones?
- Cholesterol and fatty foods
- Continuous fasting or irregular nutrition
- Passive lifestyle
- Metabolic disorders
- Diseases of the liver and digestive organs
- Diseases of the gall
- Frequent drinking and nervous stress
The danger of stones in the body
The biggest danger is the development of all kinds of complications. If your stones grow further, they can form a pressure sore on the surface of the bladder, fistula, and even an outflow into the intestines, which can lead to disastrous consequences, and even intestinal obstruction. The stones themselves pose a great threat not only to the bile, they can endanger other organs, including the pancreas.
Treatment without surgery
It all starts with nutrition, so try to take it very seriously from now on. You need to normalize lipid metabolism, lower cholesterol and purify the blood. To get started, start a low-cholesterol diet / diet. Also do not forget about the proper use of fats:
- In the morning, eat mostly creamy fats
- At lunch, fish oil (omega 3-6)
- In the evening, eat high-quality vegetable fats
Adjust your weight and give up smoking and alcohol completely, exercise regularly and go in for sports or just walking.
Nutrition tips
Is it necessary to have surgery in the presence of gallstones?
If you have 1-2 small stones, there are no gallstone problems (no blockages), there are no complications from the pancreas, there is no reflux of bile, bitterness and disturbance of the stomach, then you can not rush the operation. You can try to make yourself the right diet or try to dissolve the stones in your gallbladder. But if you have pain and eating disorders, then the operation needs to be done.
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Chronic calculous cholecystitis - This is a disease in which the formation of stones in the cavity of the gallbladder occurs, which subsequently causes inflammation of the walls of the bladder.
Cholelithiasis refers to common diseases - found in 10-15% of the adult population. In women, this disease occurs 2-3 times more often than in men. Cholecystitis is an ancient human disease. The first gallstones were discovered during a study of Egyptian mummies.
Anatomy and physiology of the gallbladder
The gall bladder is a hollow organ, pear-shaped. The gallbladder is projected approximately in the middle of the right hypochondrium.The length of the gallbladder is from 5 to 14 centimeters, and the capacity is 30-70 milliliters. In the bladder, the bottom, body and neck are distinguished.
The wall of the gallbladder consists of mucous, muscular, and connective tissue membranes. The mucosa consists of the epithelium and various glandular cells. The muscle membrane consists of smooth muscle fibers. At the neck, the mucous and muscle membranes form a sphincter, which prevents the release of bile at the wrong time.
The neck of the bladder continues into the cystic duct, which then merges with the common hepatic duct and forms the common bile duct.
The gall bladder is located on the lower surface of the liver so that the wide end of the bladder (bottom) slightly extends beyond the lower edge of the liver.
The function of the gallbladder is the accumulation, concentration of bile and the secretion of bile as necessary.
The liver produces bile and as unnecessary, bile accumulates in the gall bladder.
When bile enters the bubble, it is concentrated by absorbing excess water and trace elements with the epithelium of the bubble.
Bile secretion occurs after a meal. The muscle layer of the bladder contracts, increasing the pressure in the gallbladder to 200-300 mm. water column. Under the influence of pressure, the sphincter relaxes, and bile enters the cystic duct. Then bile enters the common bile duct, which opens into the duodenum.
The role of bile in digestion
Bile in the duodenum creates the necessary conditions for the activity of enzymes located in the pancreatic juice. Bile dissolves fats, which contributes to the further absorption of these fats. Bile is involved in the absorption of vitamins D, E, K, A in the small intestine. Also, bile stimulates the secretion of pancreatic juice.
Causes of the development of chronic calculous cholecystitis
The main reason for the appearance of calculous cholecystitis is the formation of stones.There are many factors that lead to the formation of gallstones. These factors are divided into: unchanging (those that cannot be influenced) and those that can be changed.
Invariable factors:
- Floor. Most often, women become ill due to the use of contraceptives, childbirth (estrogens, which are elevated during pregnancy - increase the absorption of cholesterol from the intestine and its abundant secretion with bile).
- Age. Persons aged 50 to 60 are more likely to suffer from cholecystitis.
- Genetic factors. These include - family predisposition, various congenital anomalies of the gallbladder.
- Ethnic factor. The greatest number of cases of cholecystitis is observed in Indians living in the southwestern United States and in the Japanese.
- Nutrition . Increased consumption of animal fats and sweets, as well as hunger and rapid weight loss can cause cholecystitis.
- Obesity In the blood and bile, the amount of cholesterol rises, which leads to the formation of stones
- Gastrointestinal tract diseases. Crohn's disease, resection (removal) of part of the small intestine
- Medications Estrogens, contraceptives, diuretics (diuretics) - increase the risk of cholecystitis.
- Hypodynamia (motionless, sedentary lifestyle)
- Decreased muscle tone of the gallbladder
How are stones formed?
Stones come from cholesterol, from bile pigments and mixed.The process of formation of stones from cholesterol can be divided into 2 phases:
First phase - violation in the bile ratio of cholesterol and solvents (bile acids, phospholipids).
In this phase, there is an increase in the amount of cholesterol and a decrease in the amount of bile acids.
An increase in cholesterol occurs due to a malfunction of various enzymes.
- decrease in hydroxylase activity (affects the reduction of cholesterol)
- decrease in acetyl transferase activity (converts cholesterol to other substances)
- increased breakdown of fats from the body fat layer (increases the amount of cholesterol in the blood).
Fatty acid reduction occurs for the following reasons.
- Violations of the synthesis of fatty acids in the liver
- Increased excretion of bile acids from the body (malabsorption of fatty acids in the intestine)
- Violation of the intrahepatic circulation
Second phase -bile saturated with cholesterol forms stasis of bile (stagnation of bile in the bladder), then the crystallization process occurs - forming crystals of cholesterol monohydrate. These crystals stick together and form stones of various sizes and compositions.
Stones consisting of cholesterol can be single or multiple, usually round or oval. The color of these stones is yellow-green. The sizes of stones vary from 1 millimeter to 3-4 centimeters.
Stones from bile pigments are formed due to an increase in the amount of unbound water-insoluble bilirubin. These stones are composed of various polymers of bilirubin and calcium salts.
Pigment stones are usually small in size up to 10 millimeters. Usually there are several in a bubble. These stones are black or gray.
Most often (80-82% of cases) mixed stones are found. They consist of cholesterol, bilirubin and calcium salts. By the number of stones are always multiple, yellow-brown.
Symptoms of gallstone disease
In 70-80% of cases, chronic calculous cholecystitis develops asymptomatically over several years. The presence of stones in the gallbladder in these cases occurs by chance - during an ultrasound scan done for other diseases.Symptoms appear only in the case of movement of the stone along the cystic canal, which leads to its blockage and inflammatory process.
Depending on the stage of cholelithiasis, the symptoms presented in the next section of the article are also distinguished.
Clinical stages of cholelithiasis
1. The stage of violation of the physico-chemical properties of bile.There are no clinical symptoms at this stage. The diagnosis can only be made by examining bile. In bile, cholesterol snowflakes (crystals) are found. Biochemical analysis of bile shows an increase in cholesterol concentration and a decrease in the amount of bile acids.
2. Latent stage.
At this stage, there are no complaints from the patient. Stones are already present in the gallbladder. The diagnosis can be made using ultrasound.
3. Stage of the onset of symptoms of the disease.
- Biliary colic is a very strong, paroxysmal and acute pain that lasts from 2 to 6 hours, sometimes more. Attacks of pain usually appear in the evening or at night.
The pain is located in the right hypochondrium and spreads to the right scapula and right cervical region. Pain appears most often after heavy, fatty foods or after a lot of physical activity.
Products after administration, which may cause pain:
- Cream
- Alcohol
- Cakes
- Carbonated drinks
Other symptoms of the disease:
- Increased sweating
- Chills
- Raising body temperature to 38 degrees Celsius
- Vomiting with bile that does not relieve
At this stage, complications such as develop:
Acute cholecystitis - This disease requires immediate surgical intervention.
Dropsy of the gallbladder. There is a blockage of the cystic duct with a stone or narrowing to a complete blockage of the duct. The exit of bile from the bladder stops. Bile from the bladder is absorbed through the walls, and a serous-mucous secretion is secreted into its lumen.
Gradually accumulating, the secret stretches the walls of the gallbladder, sometimes to enormous sizes.
Gallbladder perforation or ruptureleads to the development of biliary peritonitis (inflammation of the peritoneum).
Hepatic abscess. Limited accumulation of pus in the liver. An abscess forms after the destruction of the liver. Symptoms: high temperature up to 40 degrees, intoxication, enlarged liver.
This disease is treated only surgically.
Gall bladder cancer. Chronic calculous cholecystitis many times increases the risk of cancer.
Diagnosis of cholelithiasis
In case of the above symptoms, consult a gastroenterologist or general practitioner.Doctor talk
The doctor will ask you about your complaints. Identify the causes of the disease. He will especially dwell on nutrition (after taking, what foods do you feel bad?). Then he will enter all the data into the medical record and then proceed to the examination.
Inspection
Inspection always begins with a visual examination of the patient. If the patient complains of severe pain at the time of the examination, then his face will express suffering.
The patient will be in a lying position with legs bent and brought to the stomach. This position is forced (reduces pain). I also want to note a very important sign, when the patient flips to the left side, the pain intensifies.
Palpation (palpation of the abdomen)
With superficial palpation, flatulence (bloating) of the abdomen is determined. Hypersensitivity in the right hypochondrium is also determined. Perhaps muscle tension in the abdomen.
With deep palpation, an enlarged gallbladder can be determined (normally, the gallbladder is not palpable). Also, with deep palpation, specific symptoms are determined.
1. Murphy's symptom - the appearance of pain during inspiration at the time of palpation of the right hypochondrium.
2. Ortner's symptom - the appearance of pain in the right hypochondrium, when tapping (percussion) along the right costal arch.
Ultrasound of the liver and gall bladder
On ultrasonography, the presence of stones in the gallbladder is well defined.
Signs of the presence of stones on ultrasound:
1. The presence of solid structures in the gallbladder
2. Mobility (movement) of stones
3. Ultrasonographic hypoechoic (visible in the picture as a white gap) trace below the stone
4. Thickening of the walls of the gallbladder more than 4 millimeters
Abdominal x-ray
Stones with calcium salts are clearly visible.
Cholecystography - a study using contrast for better visualization of the gallbladder.
CT scan- carried out in the diagnosis of cholecystitis and other diseases
Endoscopic cholangiopancreatography - used to determine the location of the stone in the common bile duct.
The course of chronic calculous cholecystitis
The asymptomatic form of cholecystitis occurs for a long time. From the moment of determining stones in the gallbladder for 5-6 years, only 10-20% of patients begin to appear symptoms (complaints).
The appearance of any complications indicates an unfavorable course of the disease. In addition, many complications are treated only surgically.
Gallstone disease
Stages of treatment:1. Prevention of stone movement and related complications
2. Litholytic (grinding stones) therapy
3. Treatment of metabolic (metabolic) disorders
In the asymptomatic stage of chronic cholecystitis, the main treatment method is diet.
Diet for gallstone disease
Meal should be fractional, in small portions 5-6 times a day. The temperature of the food should be - if cold dishes are not lower than 15 degrees, and if hot dishes, then not higher than 62 degrees Celsius.Prohibited Products:
Alcoholic drinks
- bean, in any form of cooking
- dairy products with high fat content (cream, fat milk)
- any fried foods
- meat from fatty grades (goose, duck, pork, lamb), lard
- oily fish, salted, smoked fish, caviar
- any types of canned food
- mushrooms
- fresh bread (especially hot bread), croutons
- spices, spices, salinity, pickled products
- coffee, chocolate, cocoa, strong tea
- salty, hard and fatty types of cheese
Cheeses can be consumed, but low-fat
Vegetables should be consumed in boiled, baked form (potatoes, carrots). It is allowed to use chopped cabbage, ripe cucumbers, tomato. Green onion, parsley use as an addition to dishes
Meat from non-fatty varieties (beef, veal, rabbit), as well (chicken and skinless turkey). Meat should be boiled or baked. It is also recommended to use meat in minced form (cutlets)
Vermicelli and pasta allowed
Sweet ripe fruits and berries, as well as various jams and jams
Drinks: not strong tea, not sour juices, various mousses, compotes
Butter (30 grams) per dish
Allowed low-fat fish species (zander, cod, pike, bream, perch, hake). It is recommended to use fish in boiled form, in the form of cutlets, aspic
You can use whole milk. You can also add milk to various cereals.
Non-sour cottage cheese, non-acidic fat-free yogurt allowed
Effective treatment of cholecystitis when symptoms are present is possible only in a hospital!
Medication for biliary colic (pain symptom)
Typically, treatment is started with M-anticholinergics (to reduce spasm) - atropine (0.1% -1 milliliter intramuscularly) or Platifilin - 2% -1 milliliter intramuscularlyIf anticholinergic drugs do not help, antispasmodics are used:
Papaverine 2% - 2 milliliters intramuscularly or Drotaverinum (Noshpa) 2% -2 milliliters.
As painkillers, Baralgin is used 5 milliliters intramuscularly or Pentalgin is also 5 milliliters.
In case of very severe pain, Promedol 2% - 1 ml is used.
1. stones containing cholesterol
2. smaller than 5 millimeters
3. age of stones no more than 3 years
4. lack of obesity
Apply such drugs as Ursofalk or Ursosan - 8-13 mg per kilogram of body weight per day.
The course of treatment should be continued for 6 months to 2 years.
Method of direct destruction of stones
The method is based on the direct introduction of a strong solvent of stones into the gallbladder.
Extracorporeal shock wave lithotripsy - crushing stones using the energy of shock waves created outside the human body.
This method is carried out using various devices that produce various types of waves. For example, waves created by a laser, an electromagnetic installation, an ultrasound generating installation.
Any of the devices is installed in the projection of the gallbladder, then the waves from various sources act on the stones and they are crushed to small crystals.
Then these crystals are freely secreted together with bile into the duodenum.
This method is used when the stones are not more than 1 centimeter and when the gall bladder is still functioning.
In other cases, in the presence of symptoms of cholecystitis, a surgical operation to remove the gallbladder is recommended.
Gallbladder Surgical Removal
There are two main types of cholecystectomy (gallbladder removal)1. Standard cholecystectomy
2. Laparoscopic cholecystectomy
The first type has been used for a long time. The standard method is based on abdominal surgery (with an open abdominal cavity). Recently, it has been used less and less due to frequent postoperative complications.
The laparoscopic method is based on the use of a laparoscope apparatus. This device consists of several parts:
- video cameras with high magnification
- various types of tools
Advantages of 2 methods over the first:
1. Laparoscopic surgery does not require large incisions. Cuts are made in several places and are very small.
2. Cosmetic seams, so they are almost invisible
3. Performance is restored 3 times faster
4. The number of complications is ten times less
Prevention of cholelithiasis
Primary prevention - is to prevent the appearance of stones. The main method of prevention is playing sports, dieting, eliminating the use of alcohol, eliminating smoking, losing weight in the presence of excess weight.Secondary prevention consists of preventing complications. The main method of prevention is the effective treatment of chronic cholecystitis described above.
What is the danger of gallstone disease?
Gallstone disease or calculous cholecystitis is the formation of stones in the gallbladder. Often this causes a pronounced inflammatory process and leads to the appearance of serious symptoms. First of all, the disease is manifested by severe pain, a violation of the outflow of bile from the gallbladder, digestive disorders. Treatment of gallstone disease is usually referred to as a surgical profile. This is because the inflammatory process caused by the movement of stones poses a serious threat to the health and life of patients. That is why the problem is usually solved in the quickest way - by removing the gallbladder along with the stones. Gallstone disease is dangerous, first of all, with the following complications:
- Gallbladder perforation. Perforation is the rupture of the gallbladder. It can be caused by the movement of stones or too strong contraction ( spasm) smooth muscle of the organ. In this case, the contents of the organ enter the abdominal cavity. Even if there was no pus inside, bile itself can cause serious irritation and inflammation of the peritoneum. The inflammatory process extends to the intestinal loops and other neighboring organs. Most often, in the cavity of the gallbladder there are conditionally pathogenic microbes. In the abdominal cavity, they multiply rapidly, realizing their pathogenic potential and leading to the development of peritonitis.
- Gallbladder empyema. Empyema is the accumulation of pus in the natural cavity of the body. With calculous cholecystitis, the stone often gets stuck at the level of the neck of the bladder. At first, this leads to dropsy - the accumulation of mucous secretions in the organ cavity. The pressure inside increases, the walls stretch, but can spastically contract. This leads to severe pain - biliary colic. If an infection gets into such a blocked gallbladder, the mucus is converted into pus and empyema occurs. Typically, pathogens are bacteria from the genera Escherichia, Klebsiella, Streptococcus, Proteus, Pseudomonas, less commonly Clostridium and some other microorganisms. They can get inside with a blood stream or rise along the bile duct from the intestines. With the accumulation of pus, the patient's condition worsens greatly. The temperature rises, headaches intensify ( due to absorption of decay products into the blood) Without urgent surgery, the gallbladder ruptures, its contents enter the abdominal cavity, causing purulent peritonitis. At this stage ( after the break) the disease often ends with the death of the patient, despite the efforts of doctors.
- Reactive hepatitis. The inflammatory process from the gallbladder can spread to the liver, causing inflammation. The liver also suffers from a deterioration in local blood flow. As a rule, this problem ( unlike viral hepatitis) passes quite quickly after removal of the gallbladder - the main center of inflammation.
- Acute cholangitis. This complication involves blockage and inflammation of the bile duct. In this case, the outflow of bile is disturbed by a stone stuck in the duct. Since the bile ducts are connected to the ducts of the pancreas, pancreatitis can also develop in parallel. Acute cholangitis occurs with a strong fever, chills, jaundice, severe pain in the right hypochondrium.
- Acute pancreatitis. Usually due to lack of bile ( which does not stand out from the blocked bubble) or obstruction of the common duct. Pancreatic juice contains a large number of strong digestive enzymes. Their stagnation can cause necrosis ( death) of the gland itself. This form of acute pancreatitis poses a serious threat to the patient's life.
- Gall fistula. If the stones in the gallbladder do not cause severe pain, the patient can ignore them for a long time. However, the inflammatory process in the wall of the organ ( directly around the stone) is still developing. The destruction of the wall and its “soldering” with neighboring anatomical structures gradually occur. Over time, a fistula may form that connects the gallbladder to other hollow organs. Such organs can be the duodenum ( most often), stomach, small intestine, large intestine. Fistula variants between the bile ducts and these organs are also possible. If the stones themselves do not bother the patient, then fistulas can cause accumulation of air in the gallbladder, impaired outflow of bile ( and intolerance to fatty foods), jaundice, vomiting of bile.
- Paravesical Abscess. This complication is characterized by an accumulation of pus near the gallbladder. Usually an abscess is delimited from the rest of the abdominal cavity by adhesions that have arisen against the background of the inflammatory process. On top of the abscess is limited to the lower edge of the liver. Complication is dangerous by the spread of infection with the development of peritonitis, impaired liver function.
- Cicatricial strictures. The strictures are places of narrowing in the bile duct, which prevent the normal outflow of bile. In gallstone disease, this complication may occur as a result of inflammation ( the body responds with excessive formation of connective tissue - scars) or as a result of an intervention to remove stones. One way or another, strictures can persist even after recovery and seriously affect the body’s ability to digest and absorb fatty foods. In addition, if the stones are removed without removing the gallbladder, strictures can cause stagnation of bile. In general, people with such narrowing of the duct are more likely to relapse ( repeated inflammation of the gallbladder).
- Secondary Biliary Cirrhosis. This complication can occur if the stones in the gallbladder for a long time will prevent the outflow of bile. The fact is that bile enters the gallbladder from the liver. Its overflow causes stagnation of bile in the ducts in the liver itself. It can eventually lead to the death of hepatocytes ( normal liver cells) and their replacement with connective tissue, which does not perform the necessary functions. This phenomenon is called cirrhosis. The result is a serious violation of blood coagulation, impaired absorption of fat-soluble vitamins ( A, D, E, K), accumulation of fluid in the abdominal cavity ( ascites), severe intoxication ( poisoning) body.
Can calculous cholecystitis be cured without surgery?
Currently, surgery remains the most effective and justified way to treat calculous cholecystitis. When stones form in the gallbladder, as a rule, an inflammatory process develops, which not only disrupts the functioning of the organ, but also creates a threat to the body as a whole. Surgery to remove the gallbladder along with stones is the most appropriate treatment. In the absence of complications, the risk to the patient remains minimal. The organ itself is usually removed endoscopically ( without dissection of the anterior abdominal wall, through small openings).The main advantages of the surgical treatment of calculous cholecystitis are:
- A radical solution to the problem. Removing the gallbladder guarantees the cessation of pain ( biliary colic), since colic appears due to contractions of the muscles of this organ. In addition, there is no threat of relapse ( repeated exacerbations) gallstone disease. Bile will no longer be able to accumulate in the bladder, stagnate and form stones. It will come directly from the liver to the duodenum.
- Safety for the patient. Today, endoscopic removal of the gallbladder ( cholecystectomy) is a routine operation. The risk of complications during surgery is minimal. Subject to all the rules of asepsis and antiseptics, postoperative complications are also unlikely. The patient recovers quickly and can be discharged ( with the agreement of the attending physician) a few days after the operation. After a few months, he can lead the most ordinary way of life, apart from a special diet.
- The possibility of treating complications. Many patients go to the doctor too late when complications of calculous cholecystitis begin to appear. Then surgical treatment is simply necessary to remove pus, examination of neighboring organs, an adequate assessment of the risk to life.
Nowadays, there are several methods of non-surgical treatment of calculous cholecystitis. This is not about symptomatic treatment ( relieving muscle spasm, eliminating pain), namely about getting rid of stones inside the gallbladder. The main advantage of these methods is the preservation of the organ itself. If successful, the gallbladder is freed from stones and continues to fulfill its functions of accumulating and dosed secretion of bile.
There are three main methods for non-surgical treatment of calculous cholecystitis:
- Drug dissolution of stones. This method is perhaps the safest for the patient. For a long time, the patient should take drugs based on ursodeoxycholic acid. It helps dissolve stones containing bile acids. The problem is that even for the dissolution of small stones, it is necessary to take medicine regularly for several months. If we are talking about larger stones, the course may drag on for 1 - 2 years. There is no guarantee that the stones will dissolve completely. Depending on the individual characteristics of the metabolism, they may contain impurities that do not dissolve. As a result, the stones will decrease in size, the symptoms of the disease will disappear. However, this effect will be temporary.
- Ultrasonic crushing stones. Nowadays, crushing stones using ultrasonic waves is a fairly common practice. The procedure is safe for the patient, easy to perform. The problem is that the stones are crushed into sharp fragments, which still can not leave the gall bladder without injuring it. In addition, the problem of stagnation of bile is not resolved radically, and after a while ( usually a few years) stones can form again.
- Laser stone removal. It is rarely used due to its high cost and relatively low efficiency. Stones also undergo a kind of crushing and fall apart. However, even these parts can injure the mucous membrane of the organ. In addition, there is a high risk of relapse ( re-formation of stones) Then the procedure will have to be repeated.
When is gallstone surgery necessary?
Gallstone disease or calculous cholecystitis in the vast majority of cases at a certain stage of the disease require surgical treatment. This is because the stones that form in the gallbladder are usually found only with a pronounced inflammatory process. This process is called acute cholecystitis. The patient is worried about severe pain in the right hypochondrium ( colic), which are aggravated after eating. The temperature may also rise. In the acute stage, there is the possibility of serious complications, so they try to solve the problem radically and quickly. It is this decision that cholecystectomy is an operation to remove the gallbladder. Cholecystectomy involves the complete removal of the bladder along with the stones contained in it. In the uncomplicated course of the disease, it guarantees a solution to the problem, since the bile formed in the liver will no longer accumulate and stagnate. Pigments simply cannot form stones again.
There are many indications for cholecystectomy. They are divided into absolute and relative. Absolute indications are called those without which serious complications can develop. Thus, if an operation is not performed when there is absolute evidence, the patient’s life will be compromised. In this regard, doctors in such situations always try to convince the patient of the need for surgical intervention. Other treatments do not exist or they will take too much time, which will increase the risk of complications.
Absolute indications for cholecystectomy in gallstone disease are:
- A large number of stones. If gallstones ( regardless of their number and size) occupy more than 33% of the volume of the organ, cholecystectomy should be performed. To crush or dissolve such a large number of stones is almost impossible. At the same time, the organ does not work, since the walls are greatly stretched, poorly contracted, stones periodically clog the neck area and interfere with the outflow of bile.
- Frequent colic. Attacks of pain in gallstone disease can be very intense. Remove them with antispasmodic drugs. However, frequent colic suggests that drug treatment is not successful. In this case, it is better to resort to the removal of the gallbladder, regardless of how many stones are in it and what size they are.
- Stones in the bile duct. When the bile duct is blocked by a stone from the gallbladder, the patient's condition worsens greatly. The outflow of bile stops completely, the pain intensifies, obstructive jaundice develops ( due to the free fraction of bilirubin).
- Biliary Pancreatitis. Pancreatitis is called inflammation of the pancreas. This organ has a common excretory duct with the gallbladder. In some cases, with calculous cholecystitis, the outflow of pancreatic juice is impaired. The destruction of tissues in pancreatitis endangers the life of the patient, so the problem must be urgently addressed by surgical intervention.
Separately, it should be noted surgical treatment of complications of acute cholecystitis. In this case, we are talking about the spread of the inflammatory process. Problems with the gallbladder affect the work of neighboring organs. In such situations, the operation will include not only the removal of the gall bladder with stones, but also the solution of the problems formed as a result of this.
Surgical treatment without fail may also be needed for the following complications of gallstone disease:
- Peritonitis. Peritonitis is called inflammation of the peritoneum - the membrane that covers most organs of the abdominal cavity. This complication occurs when the inflammatory process spreads from the gallbladder or perforation ( the gap) of this body. Bile, and often a large number of microbes, enters the abdominal cavity, where intense inflammation begins. The operation is necessary not only to remove the gallbladder, but also for thorough disinfection of the abdominal cavity as a whole. Surgical intervention cannot be postponed, since peritonitis is fraught with the death of the patient.
- Bile duct strictures. The strictures are called channel narrowing. Such constrictions can form as a result of the inflammatory process. They impede the outflow of bile and cause its stagnation in the liver, although the gallbladder itself can be removed. Surgical intervention is necessary to eliminate strictures. As a rule, the narrowed area is enlarged or a bypass is made for bile from the liver to the duodenum. In addition to surgery, there is no effective solution to this problem.
- Accumulation of pus. Purulent complications of gallstone disease occur when an infection enters the gallbladder. If pus accumulates inside the organ, gradually filling it, this complication is called empyema. If pus accumulates near the gallbladder, but does not spread through the abdominal cavity, they speak of a paravesical abscess. The condition of the patient with these complications greatly worsens. High risk of infection. The operation includes removal of the gallbladder, emptying of the purulent cavity and its thorough disinfection to prevent peritonitis.
- Gall fistula. Bile fistulas are pathological openings between the gallbladder ( less often biliary tract) and adjacent hollow organs. Fistulas may not cause acute symptoms, but they disrupt the natural process of outflow of bile, digestion, and also predispose to other diseases. The operation is performed to close the pathological holes.
How to treat cholelithiasis folk remedies?
In the treatment of gallstone disease, folk remedies are ineffective. The fact is that with this disease in the gall bladder stones begin to form ( usually bilirubin-containing crystals) It is almost impossible to dissolve these stones by folk methods. For their splitting or crushing, respectively, powerful pharmacological preparations or ultrasonic waves are used. However, folk remedies play a role in the treatment of patients with gallstone disease. Possible effects of medicinal plants in gallstone disease are:
- Smooth muscle relaxation. Some medicinal plants relax the muscular sphincter of the gallbladder and the smooth muscles of its walls. Due to this, attacks of pain are relieved ( usually caused by spasm).
- Lower bilirubin. Elevated bilirubin in bile ( especially with prolonged stagnation) may contribute to the formation of stones.
- Outflow of bile. Due to the relaxation of the sphincter of the gallbladder, outflow of bile occurs. It does not stagnate, and crystals and stones do not have time to form in the bubble.
Thus, the effect of the use of folk remedies will be mainly preventive. Patients with impaired liver function or other factors predisposing to gallstone disease will benefit from periodically undergoing treatment. This will slow the formation of stones and prevent the problem before it occurs.
For the prevention of gallstone disease, you can use the following folk remedies:
- Radish Juice. The juice of black radish is bred with honey in equal proportions. You can also cut a cavity in radish and pour honey there for 10 - 15 hours. After this, a mixture of juice and honey is consumed in 1 tablespoon 1 to 2 times a day.
- Barberry leaves. Green leaves of barberry are thoroughly washed with running water and filled with alcohol. For 20 g of crushed leaves, 100 ml of alcohol is needed. Infusion lasts 5 to 7 hours. After this, tincture is drunk 1 teaspoon 3-4 times a day. The course lasts 1 to 2 months. Six months later, it can be repeated.
- Mountain ash infusion. 30 g of rowan berries are poured into 500 ml of boiling water. Insist 1 to 2 hours ( until the temperature drops to room temperature) Then the infusion is taken half a cup 2 to 3 times a day.
- Mummy. Mummies can be taken both to prevent the formation of stones, and with gallstone disease ( if the diameter of the stones does not exceed 5 - 7 mm) It is bred in a ratio of 1 to 1000 ( 1 g mummy per 1 liter of warm water) Before eating, drink 1 cup of the solution three times a day. This tool can be used no more than 8 - 10 days in a row, after which you need to take a break of 5 - 7 days.
- Mint with celandine. Equal proportions of dry leaves of these herbs are used in the form of infusion. For 2 tablespoons of the mixture, 1 liter of boiling water is needed. Infusion lasts 4 to 5 hours. After this, the infusion is consumed in 1 glass per day. Sediment ( grass) filtered before use. It is not recommended to store the infusion for more than 3 to 4 days.
- Highlander Serpentine. To prepare the broth, you need 2 tablespoons of dry chopped rhizomes, pour 1 liter of boiling water and cook for 10 - 15 minutes over low heat. 10 minutes after turning off the heat, the broth is decanted and allowed to cool ( usually 3 to 4 hours) The broth is taken in 2 tablespoons half an hour before meals twice a day.
For the prevention of stagnation of bile with the help of blind sounding, pharmacological preparations or some natural mineral waters can be used. Water or medicine should be drunk on an empty stomach, after which the patient lies on his right side, placing it under the right hypochondrium ( on the area of \u200b\u200bthe liver and gall bladder) a warm heating pad. You need to lie 1 - 2 hours. During this time, the sphincter will relax, the bile duct will expand, and bile will gradually enter the intestines. A dark stool with an unpleasant odor after a few hours indicates the success of the procedure. It is advisable to consult with your doctor about the method of conducting blind sounding and its advisability in each case. After the procedure, you need to follow a fat-free diet for several days.
Thus, folk remedies can successfully prevent the formation of stones in the gallbladder. In this case, the regularity of treatment courses is important. It is also advisable to undergo preventive examinations by a doctor. This will help detect small stones ( using ultrasound) in case folk methods do not help. After the formation of stones, the effectiveness of traditional medicine is greatly reduced.
What are the first signs of gallstone disease?
Gallstone disease can proceed secretively for a long time, without manifesting itself. During this period, stagnation of bile in the gallbladder and the gradual formation of stones occur in the patient's body. Stones are formed from pigments contained in bile ( bilirubin and others), and resemble crystals. The longer stagnation of bile, the faster such crystals grow. At a certain stage, they begin to injure the inner shell of the organ, interfere with the normal contraction of its walls and prevent the normal outflow of bile. From this moment, the patient begins to experience certain problems. Usually gallstone disease manifests itself for the first time as follows:
- Heaviness in the stomach. The subjective feeling of heaviness in the abdomen is one of the first manifestations of the disease. Most patients complain about it when they see a doctor. The severity is localized in the epigastrium ( under the spoon, in the upper abdomen) or in the right hypochondrium. It can appear spontaneously, after physical exertion, but more often - after eating. This sensation is due to stagnation of bile and an increase in the gallbladder.
- Pain after eating. Sometimes the first symptom of the disease is pain in the right hypochondrium. In rare cases, it is biliary colic. It is a strong, sometimes unbearable pain that can give to the right shoulder or shoulder blade. However, more often the first bouts of pain are less intense. It is rather a feeling of heaviness and discomfort, which during movements can turn into stitching or bursting pain. Discomfort occurs an hour and a half after eating. Especially often pain attacks are observed after taking a large amount of fatty foods or alcohol.
- Nausea. Nausea, heartburn, and sometimes vomiting can also be the first manifestations of the disease. They also appear usually after eating. The connection of many symptoms with food is due to the fact that the gallbladder normally secretes some bile. It is needed for emulsification ( a kind of dissolution and assimilation) fats and the activation of certain digestive enzymes. In patients with stones in the gallbladder, bile secretion does not occur, food is digested worse. Therefore, nausea occurs. The reverse reflux of food into the stomach leads to belching, heartburn, gas accumulation, and sometimes vomiting.
- Chair changes. As mentioned above, bile is necessary for the normal absorption of fatty foods. With uncontrolled bile secretion, prolonged constipation or diarrhea can occur. Sometimes they appear before other symptoms typical of cholecystitis. In later stages, the stool may discolor. This means that the stones clogged the ducts, and bile practically does not stand out from the gallbladder.
- Jaundice. Yellowing of the skin and sclera of the eyes is rarely the first symptom of gallstone disease. Usually it is observed after digestive problems and pain. Jaundice is caused by stagnation of bile not only at the level of the gallbladder, but also in the ducts inside the liver ( where bile is formed) Due to disruption of the liver, a substance called bilirubin accumulates in the blood, which is normally excreted with bile. Bilirubin enters the skin, and its excess gives it a characteristic yellowish tint.
Usually the first symptoms and manifestations of gallstone disease are difficult to make a correct diagnosis. Nausea, vomiting, and digestive disorders can occur with disorders in other organs of the digestive system. To clarify the diagnosis, an ultrasound scan is prescribed ( ultrasound procedure) abdominal cavity. It allows you to detect a characteristic increase in the gallbladder, as well as the presence of stones in its cavity.
Can calculous cholecystitis be treated at home?
Where treatment of calculous cholecystitis will occur depends entirely on the patient's condition. Hospitalization is usually subject to patients with acute forms of the disease, however, there may be other indications. At home, gallstone disease can be treated with medication if it proceeds in a chronic form. In other words, a patient with stones in the gallbladder does not need urgent hospitalization if he does not have acute pain, fever or other signs of inflammation. However, sooner or later the question arises of surgical removal of the problem. Then, of course, you must go to the hospital. In general, hospitalization of the patient is recommended in the following cases:
- Acute forms of the disease. In acute course of calculous cholecystitis, a serious inflammatory process develops. Without proper patient care, the course of the disease can be very complicated. In particular, we are talking about the accumulation of pus, the formation of an abscess or the development of peritonitis ( inflammation of the peritoneum) In the acute course of the disease, hospitalization cannot be delayed, since the above complications can develop within 1 to 2 days after the first symptoms.
- First signs of the disease. It is recommended that patients in a hospital for the first time exhibit symptoms and signs of calculous cholecystitis. There he will be done within a few days all the necessary research. They will help to understand exactly what form of the disease the patient has, what is his condition, whether there is a question about urgent surgical intervention.
- Accompanying illnesses. Cholecystitis can develop in parallel with other health problems. For example, in patients with chronic heart failure, diabetes mellitus or other chronic diseases, it can cause exacerbation and serious deterioration. For careful monitoring of the course of the disease, it is recommended to put the patient in the hospital. There, if necessary, any help will be quickly provided.
- Patients with social problems. Hospitalization is recommended for all patients who cannot be provided with emergency care at home. For example, a patient with chronic cholelithiasis lives very far from the hospital. In case of exacerbation, it will not be possible to quickly provide qualified assistance ( usually it’s about surgery) During transportation, serious complications may develop. A similar situation arises with older people who have no one to care for at home. In these cases, it makes sense to operate not even an acute process. This will eliminate the exacerbation of the disease in the future.
- Pregnant women. Calculous cholecystitis in pregnant women is associated with a higher risk for both the mother and the fetus. In order to have time to provide assistance, it is recommended to hospitalize the patient.
- Patient desire. Any patient with chronic cholelithiasis can voluntarily go to the hospital for surgical removal of gallstones. This is much more profitable than operating an acute process. Firstly, the risk of complications during surgery and in the postoperative period is reduced. Secondly, the patient chooses the time ( vacation, planned sick leave, etc.) Thirdly, it deliberately eliminates the risk of repeated complications of the disease in the future. The prognosis for such planned operations is much better. Doctors have more time for a thorough examination of the patient before treatment.
At home, the disease can be treated under the following conditions:
- chronic course of cholelithiasis ( no acute symptoms);
- finally formulated diagnosis;
- strict adherence to the instructions of a specialist ( regarding prevention and treatment);
- the need for long-term drug treatment ( for example, non-surgical dissolution of stones can last 6-18 months);
- the possibility of patient care at home.
Can I play sports with gallstone disease?
Gallstone disease or calculous cholecystitis is a fairly serious disease, the treatment of which must be taken very seriously. The formation of stones in the gallbladder may not cause tangible symptoms at first. Therefore, some patients even after accidentally detecting a problem ( during preventive ultrasound examination) continue to lead a habitual life, neglecting the regimen prescribed by the doctor. In some cases, this can lead to accelerated progression of the disease and the deterioration of the patient's condition. One of the important conditions of a preventive regimen is the restriction of physical activity. This is necessary after the discovery of stones, during the acute stage of the disease, as well as during treatment. In this case, we are talking not only about professional athletes, the preparation of which requires all efforts, but also about everyday physical exertion. At each stage of the disease, they can affect the course of events in different ways.
The main reasons for limiting physical activity are:
- Accelerated bilirubin formation. Bilirubin is a natural metabolic product ( metabolism) This substance is formed during the breakdown of hemoglobin, the main component of red blood cells. The greater physical activity a person performs, the faster red blood cells break up and the more hemoglobin enters the bloodstream. As a result, the level of bilirubin also rises. This is especially dangerous for people who have stagnation of bile or a predisposition to stone formation. In the gallbladder, bile accumulates with a high concentration of bilirubin, which gradually crystallizes and forms stones. Thus, people who already have cholestasis ( stagnation of bile), but the stones have not yet formed, heavy physical exertion is not recommended as a preventive measure.
- Movement of stones. If the stones have already formed, then serious loads can lead to their movement. Most often, the stones are located in the bottom of the gallbladder. There they can cause a mild inflammatory process, but do not prevent the outflow of bile. As a result of physical activity, intra-abdominal pressure rises. This is reflected to some extent on the gallbladder. It is compressed, and the stones can move, moving to the neck of the organ. There, the stone gets stuck at the level of the sphincter or in the bile duct. As a result, a serious inflammatory process develops, and the disease acquires an acute course.
- Symptom Progression. If the patient already has digestive disorders, pain in the right hypochondrium or other symptoms of gallstone disease, then physical exertion can provoke an exacerbation. For example, pain due to inflammation can go into biliary colic. If the symptoms are caused by the movement of stones and blockage of the bile duct, then they will not disappear after the cessation of physical activity. Thus, there is a chance that even a one-time exercise ( running, jumping, weight lifting, etc.) may lead to urgent hospitalization and surgery. However, we are talking about people who already suffer from a chronic form of the disease, but do not follow the regimen prescribed by the doctor.
- The risk of cholelithiasis complications. Calculous cholecystitis is almost always accompanied by an inflammatory process. Initially, it is caused by mechanical injury to the mucous membrane. However, many patients also develop an infectious process. As a result, pus can form and accumulate in the cavity of the bladder. If in such conditions the abdominal pressure rises sharply or the patient makes a sharp unsuccessful turn, the swollen gall bladder may burst. The infection will spread throughout the abdominal cavity and peritonitis will begin. Thus, sports and physical activity in general can contribute to the development of serious complications.
- The risk of postoperative complications. Often, acute cholecystitis has to be treated surgically. There are two main types of operations - open when an abdominal wall is cut, and endoscopic when removal occurs through small openings. In both cases, after surgery, any physical activity is contraindicated for some time. With an open operation, healing takes longer, more sutures are applied, and the risk of their divergence is higher. With endoscopic removal of the gallbladder, the patient recovers faster. As a rule, full loads are allowed to be given only 4-6 months after surgery, provided that the doctor does not see other contraindications to this.
- daily walks of 30-60 minutes at an average pace;
- gymnastic exercises without sudden movements with limited load on the abdominal press;
- swimming ( not for speed) without diving to great depths.
Is pregnancy dangerous with gallstone disease?
Gallstone disease in pregnant women is a fairly common phenomenon in medical practice. On the one hand, this disease is characteristic of older women. However, it is during pregnancy that there are quite a few prerequisites for the appearance of stones in the gallbladder. Most often, it occurs in patients with a hereditary predisposition or with chronic liver diseases. According to statistics, exacerbation of gallstone disease usually occurs in the third trimester of pregnancy. The prevalence of this problem during pregnancy is explained as follows:
- Metabolic changes. As a result of hormonal changes, the metabolism in the body also changes. This can lead to accelerated stone formation.
- Motility Changes. Normally, the gallbladder accumulates bile and contracts, releasing it in small portions. During pregnancy, the rhythm and strength of its contractions are violated ( dyskinesia) As a result, bile congestion may develop, which contributes to the formation of stones.
- Increased abdominal pressure. If a woman already had small stones in the gallbladder, then the growth of the fetus can lead to their movement. This is especially characteristic in the third trimester, when the growing fetus pushes up the stomach, colon and gall bladder. There is a squeezing of these organs. As a result, stones located near the bottom of the bubble ( in its upper part), can get into the bile duct and clog it. This will lead to the development of acute cholecystitis.
- Sedentary lifestyle. Pregnant women often neglect walking or elementary physical exercises, which contribute, among other things, to the normal functioning of the gallbladder. This leads to stagnation of bile and accelerate the formation of stones.
- Diet change. Changing eating habits can affect the composition of the microflora in the intestines, impair the motility of the bile ducts. If at the same time the woman had latent ( asymptomatic) form of gallstone disease, the risk of exacerbation increases significantly.
Exacerbation of gallstone disease during pregnancy is especially dangerous for the following reasons:
- high risk of rupture due to increased intra-abdominal pressure;
- high risk of infectious complications ( including purulent processes) due to weakened immunity;
- fetal intoxication due to the inflammatory process;
- fetal malnutrition due to poor digestion ( food is absorbed worse, since bile does not enter the duodenum);
- limited treatment options ( not all drugs and treatment methods that are usually used for gallstone disease are suitable for pregnant women).
In the absence of complications of gallstone disease, the prognosis for the mother and child remains favorable. If the patient turned to the specialist too late, and the inflammatory process began to spread in the abdominal cavity, the question of removing the fetus by caesarean section may be raised. The prognosis in this case is somewhat worsening, since we are talking about technically difficult surgical intervention. It is necessary to remove the gall bladder, remove the fetus, carefully examine the abdominal cavity to prevent the development of peritonitis.
What are the types of calculous cholecystitis?
Calculous cholecystitis is not the same in all patients. This disease is caused by the formation of stones in the gallbladder, due to which an inflammatory process develops. Depending on how this process will proceed, as well as on the stage of the disease, several types of calculous cholecystitis are distinguished. Each of them has not only its own characteristics of the course and manifestation, but also requires a special approach to treatment. In terms of the main manifestations of the disease(clinical form) The following types of calculous cholecystitis are distinguished:
- Stone Carriage. This form is latent. The disease does not manifest itself. The patient feels great, does not experience any pain in the right hypochondrium, or digestive problems. However, the stones have already formed. They gradually increase in quantity and size. This will happen until the accumulated stones begin to disrupt the organ. Then the disease will begin to manifest. Stone carriage can be detected by prophylactic ultrasound. It is harder to notice stones on a panoramic x-ray of the abdominal cavity. When stone-bearing is discovered, it is not an emergency operation. Doctors have time to try other treatments.
- Dyspeptic form. With this form, the disease manifests itself in a variety of digestive disorders. At first it is difficult to suspect cholecystitis, since there are no typical pains in the right hypochondrium. Patients are concerned about the severity in the stomach, in the epigastrium. Often after a hearty meal ( especially fatty foods and alcohol) there is an eructation with a taste of bitterness in the mouth. This is due to impaired bile secretion. Also, patients may have problems with stool. In this case, an ultrasound examination will help confirm the correct diagnosis.
- Biliary colic. In fact, biliary colic is not a form of gallstone disease. This is a common specific symptom. The problem is that in the acute stage of the disease, severe pain attacks often appear ( every day, and sometimes more often) The effect of antispasmodic drugs is temporary. Biliary colic is caused by a painful contraction of smooth muscles in the walls of the gallbladder. They are usually observed with stones of large sizes, overstretching of an organ, getting a stone into the bile duct.
- Chronic recurrent cholecystitis. A recurring form of the disease is characterized by repeated bouts of cholecystitis. The attack is manifested by severe pain, colic, fever, characteristic changes in blood tests ( leukocyte count and erythrocyte sedimentation rate increase - ESR) Relapses occur with unsuccessful attempts at conservative treatment. Medications temporarily slow down the inflammatory process, and some medical procedures can temporarily improve the outflow of bile. But while there are stones in the gallbladder cavity, the risk of relapse remains high. Surgery ( cholecystectomy - gallbladder removal) once and for all solves this problem.
- Chronic residual cholecystitis. This form is not recognized by all specialists. It is sometimes talked about in cases where an attack of acute cholecystitis has passed. The patient's temperature decreased, and the general condition returned to normal. However, the symptoms left moderate pain in the right hypochondrium, which intensifies with palpation ( probing this area) Thus, this is not about full recovery, but about transition to a special form - residual ( residual) cholecystitis. As a rule, over time, the pain disappears or the disease worsens again, turning into acute cholecystitis.
- Angina pectoris. It is a rare clinical form of calculous cholecystitis. Its difference from others is that the pain from the right hypochondrium spreads to the region of the heart and provokes an attack of angina pectoris. Heart rhythm disturbances and other symptoms of the cardiovascular system may also be observed. This form is more common in patients with chronic coronary heart disease. Biliary colic in this case plays the role of a kind of "trigger". The problem is that due to an attack of angina pectoris, doctors often do not immediately find out the main problem - calculous cholecystitis itself.
- Saint Syndrome. It is a very rare and poorly understood genetic disease. With it, the patient has a tendency to form stones in the gallbladder ( actually calculous cholecystitis), arising, apparently, due to the lack of certain enzymes. In parallel, diverticulosis of the colon and diaphragmatic hernia are observed. This combination of defects requires a special approach to treatment.
