Gallstone disease (ICD) is a pathological process, accompanied by the formation of calculus in the gallbladder.
The second name of the disease is calculous cholecystitis. Since GCB affects the organ of the digestive tract (gallbladder), it is usually treated by a gastroenterologist.
Features of gallstones
Calculi are the main manifestation of gallstone disease. They consist of calcium, cholesterol and bilirubin, and may have different sizes. With a small amount, we are talking about the so-called "sand" in the gallbladder, but if the formations are large, they are considered to be full-fledged stones (stones).
Such formations may increase in size over time. So, from a small grain of sand can occur stone sizes of 1 cm or more. A calculus can have a different shape - from round or oval to the outlines of a polyhedron. The same applies to the density of stones. There are quite strong concretions, but there are also very fragile ones that can crumble from a single touch.
The surface of the stone may be flat, spiky or porous (in cracks). These features are characteristic of all stones, regardless of their location. However, often the stones are found in the gallbladder. This anomaly is called gallstone disease, or calculus of the gallbladder. Less commonly, stones are detected in the bile ducts. This disease is called choledocholithiasis.
Concrements in the gallbladder can be either single or multiple. There may be dozens, even hundreds. However, it should be remembered that the presence of even one calculus can cause serious harm to health. Moreover, dangerous complications are often the result of small, rather than large gallstones.
Causes of stone formation
If for some reason the quantitative balance of the components that make up the bile is disturbed, solid structures - flakes - are formed. As they grow, they merge to form stones. Often the disease develops under the influence of an accumulation of an excessively large amount of cholesterol in the bile. In this case, bile is called lithogenic.
Hypercholesterolemia may result from:
- abuse of fatty foods containing large amounts of cholesterol;
- reducing the amount of specific acids entering the bile;
- reducing the amount of phospholipids that prevent the hardening and settling of bilirubin and cholesterol;
- stagnation of bile.
Bile stasis can be mechanical or functional. If we are talking about the mechanical nature of this deviation, then factors such as:
- excesses of the gallbladder;
- enlargement of adjacent organs or lymph nodes;
- scar formation;
- inflammatory processes accompanied by edema of the organ wall;
Functional failures are associated with impaired motility of the gallbladder itself. In particular, they occur in patients with hypokinetic biliary dyskinesia. In addition, the development of cholelithiasis may be the result of disorders in the biliary system, infectious and allergic diseases, pathologies of an autoimmune nature, etc.
Gallstone disease is divided into several stages:
- Physicochemical or pre-stone. This is the initial stage of cholelithiasis. During its course, there are gradual changes in the composition of bile. No special clinical manifestations at this stage does not occur. It is possible to detect the initial stage of JCB during a biochemical study of the composition of bile.
- Phase latent (hidden) carrier. At this stage, the stones in the gallbladder or its ducts are just beginning to form. The clinical picture is also not typical for this phase of the pathological process. To identify gallstone tumors is possible only during the instrumental diagnostic procedures.
- The stage when the symptoms of the disease begins to appear brighter and harder. In this case, it is possible to speak about the development of acute calculous cholecystitis, or to state the fact of its transition to the chronic form.
In some sources you can see the four-step gradation of gallstone disease. The last, fourth, phase of the disease is characterized as such, at which the associated complications of the pathological process develop.
Types of gallstones
Stones localized in the gallbladder may have a different chemical composition. According to this criterion, they are usually divided into:
- Cholesterol. Cholesterol is one of the components of bile, but if it is oversupplied, stones can form. This substance enters the human body with food, and is evenly distributed among its cells, contributing to its full functioning. If there is a violation of the process of assimilation of cholesterol, it begins to accumulate in the bile, forming stones. Cholesterol stones have a round or oval shape, and can reach from 1 to 1.5 centimeters in diameter. Their location often becomes the bottom of the gallbladder.
- Bilirubin. Bilirubin is a breakdown product of hemoglobin. Stones that are formed when it is abundant in the body, also called pigment. Bilirubin stones are inferior in size to cholesterol, but there may be more of them. At the same time, they affect not only the bottom of the gallbladder, but are also able to localize in the biliary tract.
Gallstones can have varying degrees of calcium saturation. It depends on how clearly you can see the tumor on the screen of the ultrasound machine or on the radiograph. In addition, the choice of therapeutic technique depends on the degree of saturation of calculus with calcium. If the stone is calcified, it means that it will be much more difficult to cope with it using drugs.
Depending on the size of the gallstones are:
- Small. The size of such tumors does not exceed 3 cm in diameter. With single stones localized in the area of the bottom of the gallbladder, no specific clinical symptoms of the patient manifest.
- Large. These are called stones, the diameter of which exceeds 3 cm. They prevent the normal outflow of bile, and can cause attacks of biliary colic, or other unpleasant symptoms.
Not only the species, but also the size of the stones can affect the choice of therapeutic tactics in JCB. Large stones, as a rule, do not undergo medical dissolution. They are also not crushed using ultrasound, since such a therapeutic approach is unlikely to give the expected results.
In this case, cholecystectomy occurs - an operation to remove the gallbladder, along with the stones in it. If the stones are small, more gentle treatment methods are considered.
In some cases, the attention of doctors may also be concentrated on the location of the neoplasms. Stones located in the bottom of the gallbladder, rarely disturb the patient, because they are not typical of any clinical picture.
If the stones are localized in close proximity to the neck of the diseased organ, this may cause obstruction of the bile duct. In this case, the patient will be disturbed by unpleasant symptoms, manifested by pain in the right hypochondrium and impaired digestion.
Symptoms and signs of gallstone disease
Gallstone disease is a pathological process that can be completely asymptomatic for a long time. This is especially true of the initial stages of the disease, when the stones are still too small, and therefore do not clog the bile ducts, and do not injure the bladder wall.
A patient may not know for a long time about the presence of the disease, that is, to be a latent stone carrier. When the neoplasms reach a rather large size, the first warning signs of the pathological process in the gallbladder appear. They can manifest themselves in different ways.
The first symptoms of cholelithiasis, which occur before the appearance of pain in the right hypochondrium, include:
- feeling of heaviness in the abdomen after eating;
- bouts of nausea;
- slight yellowing of the skin (obstructive jaundice).
This clinical picture occurs due to a violation of the process of outflow of bile. Under the influence of such a failure, deviations in the work of the organs of the digestive tract occur.
The most common symptoms and signs of JCB include:
- Pains in the right hypochondrium, which indicate the development of biliary colic. The duration of the attack can last from 10 minutes to several hours, while the pain can be acute, unbearable, and give to the right shoulder, other parts of the abdomen or back. If the attack does not go away within 5-6 hours, the patient may develop serious complications.
- Increased body temperature, indicating the development of acute cholecystitis - a disease that is a frequent companion of JCB. Intensive inflammation of the gallbladder leads to an active release of toxic substances into the blood. If there are frequent bouts of pain after biliary colic, and they are accompanied by fever, this indicates the development of acute cholecystitis. If the temperature rises are temporary, and the thermometer marks reach 38 ° C, this may indicate the occurrence of cholangitis. But, nevertheless, the temperature is not a mandatory sign of JCB.
- The development of jaundice. This anomaly arises due to long-term stagnation processes due to violations of the outflow of bile. First of all, the ocular sclera turn yellow, and only then - the skin. In people with fair skin, this symptom is more noticeable than in swarthy patients. Often, along with the yellowing of the skin and whites of the eyes in patients with changes in color and urine. It acquires a dark shade, which is associated with the release of a large amount of bilirubin by the kidneys. In case of calculous cholecystitis, jaundice is only an indirect, but not obligatory symptom. In addition, it can become a consequence of other diseases - cirrhosis, hepatitis, etc.
- Acute response to fat intake. Under the influence of bile is the splitting and absorption of lipids in the blood. If the stones are located near the neck or bile duct in the gallium bladder, they simply block the path of bile. As a result, it cannot circulate normally in the intestine. This anomaly causes the occurrence of diarrhea, nausea, flatulence, dull pain in the abdomen. But these symptoms are not specific manifestations of gallstones, as they occur in most gastrointestinal diseases. Intolerance to fatty foods can occur at different stages of the development of gallstone disease. However, even a large calculus, if it is located at the bottom of the diseased organ, is not an obstacle to the flow of bile. Consequently, fatty foods will be digested and assimilated quite normally.
If we talk about the overall symptoms of JCB, then it can be quite diverse. There may be different in intensity and nature of abdominal pain, digestive disorders, nausea, sometimes with bouts of vomiting. But since the clinical picture of the disease is characteristic of many pathologies of the gastrointestinal tract, experienced doctors always prescribe an ultrasound of the gallbladder to understand the cause of the patient’s discomfort.
If there is symptomatology characteristic of biliary colic, you should immediately contact a specialist. First of all, a physical examination and anamnesis are conducted, based on finding out exactly what symptoms the patient suffers from.
On palpation of the abdomen there is tension and soreness of the skin in the muscles of the abdominal wall in the immediate vicinity of the diseased gallbladder. In addition, the doctor notes that the patient has yellowish spots on the skin, which are caused by a violation of lipid metabolism, yellowing of the eye sclera and skin.
But a physical examination is not a basic diagnostic procedure. This is a preliminary examination, which gives the doctor a reason to refer a patient for certain studies. In particular:
- Clinical blood test. If there is an inflammatory process in the gallbladder, a moderate increase in ESR and pronounced leukocytosis will be noticed in the test results.
- Blood chemistry. When deciphering the data by a doctor, an increased level of cholesterol and bilirubin is observed against the background of abnormal alkaline phosphatase activity.
- Cholecystography. This diagnostic technique helps to accurately examine the condition of the gallbladder. During the procedure, an increase in the organ and the appearance of calcareous inclusions on its walls are detected. With the help of cholecystography, calcareous stones located inside the diseased organ are detected.
- Abdominal ultrasound is the most informative diagnostic technique for suspected gallstone disease. In addition to identifying tumors, specialists noted the deformation of the gallbladder wall. Also recorded negative changes in the motility of the patient's body. Clearly visible on ultrasound and signs characteristic of cholecystitis.
A thorough study of the state of the gallbladder is also possible with an MRI or CT scan. No less informative diagnostic technique, during which violations in the circulation of bile are detected, is scintigraphy. The retrograde endoscopic cholangiopancreatography method is also widely used.
The formation of stones in the gallbladder is fraught with not only a violation of the motility of the diseased organ. The GCB can have a very negative effect on the functioning of other organs, especially those that are in close proximity to the GC.
Thus, the edges of stones can injure the walls of the bladder, causing the development of inflammatory processes in them. In severe cases, neoplasms clog the entrance and exit of the gall, thereby complicating the flow of bile. When such deviations begin to occur stagnant processes, leading to the development of inflammation. This process can take from several hours to several days, but sooner or later it will definitely be felt. The extent of the lesion and the intensity of the pathological phenomenon may be different.
So, the formation of a small swelling of the gallbladder wall, or its destruction, is possible. The consequence of this dangerous process is the rupture of the diseased organ. Such a complication of gallstone disease directly threatens the patient's life.
The spread of the inflammatory process in the abdominal organs is fraught with the development of peritonitis. A complication of this condition can be toxic shock or multiple organ failure. With its development, serious malfunctions in the functioning of the heart, kidneys, blood vessels and even the brain occur.
If the inflammation is too intense, and the pathogens release an excessive amount of toxins into the blood, it can appear immediately. Under such circumstances, even immediate resuscitation is not a guarantee of the patient’s exit from a dangerous state and the prevention of death.
Treatment of gallstone disease
Pathology treatment can be conservative and surgical. As a rule, therapeutic methods are used to begin with. These include:
- Dissolving gallstones with the help of special medications. In particular, chenodeoxycholic and ursodeoxycholic acid. This technique is effective only with single cholesterol calculi. In the absence of contraindications to the patient, such therapy is prescribed for a year and a half.
- Extracorporeal shock wave lithotripsy is a conservative method for the treatment of gallstones, involving the use of a shock wave, which leads to the destruction of gallstones. Such a wave is created with the help of special medical devices. Such treatment of GCB is carried out only with cholesterol stones of small size (up to 3 cm). The procedure practically does not cause pain and is rather easily tolerated by patients. Pieces of stones are excreted during bowel movements.
- Diet. This is one of the foundations of a successful recovery and removal of unpleasant symptoms. Throughout the course of diet therapy, you must follow the rules of fractional nutrition. Food should be taken 4-6 times a day in small portions. Fatty, spicy, fried, spicy dishes, smoked meats, pickles, carbonated and alcoholic drinks, chocolate are necessarily excluded from the diet. The patient should abandon fatty meats and spicy seasonings. Healthy nutrition in JCR is based on the use of dairy products and plant products. It is necessary to add wheat bran to the menu.
The surgical treatment for cholelithiasis, cholecystectomy, is particularly popular today. It is carried out in 2 ways:
Only the surgeon can determine which type of operation it is advisable to carry out in each individual case. Cholecystectomy is mandatory when:
- Numerous tumors in the gallbladder. At the same time, the exact number and size of stones do not play any role. If they occupy at least 33% of the area of the diseased organ, cholecystectomy is mandatory. Neither crush nor dissolve this number of stones is not possible.
- Frequent bouts of biliary colic. Pain with this deviation can be quite intense and frequent. They are removed using antispasmodic drugs, but sometimes this treatment does not bring relief. In this case, doctors resort to surgical intervention, regardless of the number of stones and their diameter.
- The presence of stones in the bile ducts. Obturation of the biliary tract conceals a serious threat to the patient's health, and significantly worsens his health. The outflow of bile is disturbed, the pain syndrome becomes more intense and mechanical jaundice develops. In this situation, the operation can not do.
- Biliary pancreatitis. Pancreatitis is an inflammatory process that develops and occurs in pancreatic tissues. PZHZH and the gallbladder are connected by one bile duct, therefore a disruption in the work of one organ entails negative changes in the work of another. In some cases, calculous cholecystitis leads to disruption of pancreatic juice outflow. The destruction of organ tissue can lead to serious complications, and directly threatens the patient’s life. The problem must be solved exclusively by surgery.
Mandatory surgery is also required for:
- Peritonitis Inflammation of the abdominal organs and tissues of the peritoneum itself is a dangerous condition that can be fatal. The pathological process can develop when the gallbladder ruptures and bile contaminated with pathogenic microorganisms enters the abdominal cavity. In this case, the operation is aimed not only at the removal of the affected organ, but also at thorough disinfection of adjacent organs. Delay in surgery can be fatal.
- Stricture of biliary ducts. The narrowing of the canal is called a stricture. Intensive inflammatory process can lead to such violations. They lead to stagnation of bile and its accumulation in the tissues of the liver, although the gallbladder can be removed. During surgical intervention, the efforts of the surgeon are aimed at eliminating strictures. The narrowed area can be expanded, or a bypass route for bile can be created by the doctor, by which it is brought directly into the rectum. Without surgical intervention to normalize the situation is impossible.
- Congestion of pus content. When a bacterial infection joins the tissues of the gallbladder, pus accumulates in them. The accumulation of pus inside the gallbladder itself is called an empyema. If the pathological content is collected outside of it, without affecting the organs of the abdominal cavity, in this case we are talking about the development of paravesical abscess. Such anomalies lead to a sharp deterioration of the patient. During the operation, the gallbladder is removed and the abscess is emptied, followed by careful treatment with antiseptics to prevent peritonitis.
- Bile fistula - pathological holes localized between the gallbladder (less often - its ducts) and adjacent hollow organs. For such a deviation, any specific clinical picture is uncharacteristic, but it can significantly disrupt the outflow of bile, leading to its stagnation. In addition, they can cause the development of other diseases and digestive disorders. Pathological holes are closed during surgery, which helps prevent unwanted complications.
In addition to the stage of the pathology, the size and composition of the stones, the patient's age and the presence of concomitant diseases play a large role in the choice of the therapeutic technique. In case of intolerance to pharmacological agents, drug treatment of GCB is contraindicated to the patient. In this case, the only correct way out of this situation will be the operation.
But for older people with diseases of the cardiovascular system, kidneys or other organs, surgery can only harm. In this case, doctors try to avoid similar tactics of treatment.
As can be seen, the choice of treatment methods for JCB depends on many factors. Accurately say whether there is a need for surgery, can only the attending physician after all the necessary diagnostic measures.
Diet for cholelithiasis
Food at JCB should be fractional. Food should be taken in small portions 4-6 times a day. Food temperature should not be less than 15 or more than 62 degrees Celsius. For prohibited products in JCB include:
- legumes in any form;
- fat milk and sour milk products;
- fatty fish and meat;
- canned food;
- mushrooms in any form;
- hot fresh bread, toast, croutons;
- spices, seasonings;
- chocolate products;
- strong black tea;
- hard or salted cheese.
And, on the contrary, doctors recommend to give preference:
- dried bread made from flour of the 2nd grade;
- low-fat cheeses;
- boiled, steamed or baked vegetables;
- finely chopped white cabbage (in limited quantities);
- baked or boiled lean meat;
- different types of cereals;
- noodles and pasta (within reason);
- jams and jam;
- sweet fruits and berries;
- weak tea;
- sweet homemade juices;
- dried fruit compote;
- butter, which must be added to various dishes in an amount of not more than 30 g per day;
- low-fat fish varieties (zander, pike, hake, etc.);
- whole milk It can be used both in pure form and used for cooking porridges.
Low-fat cottage cheese and natural low-fat yogurts are also allowed (home cooking is better).
Prognosis and prevention of JCB
To prevent the development of cholelithiasis, it is necessary, if possible, to avoid factors that can cause the development of hypercholesterolemia and bilirubinemia. It is also important to eliminate congestive processes in the gallbladder and its ducts. This is facilitated by:
- balanced and good nutrition;
- physical activity;
- careful monitoring of body weight, and, if necessary, its adjustment;
- timely detection and complete cure of diseases of the biliary system.
Especially close attention to the circulation of bile and cholesterol should be given to people who have a genetic predisposition to cholelithiasis.
If we talk about the prevention of biliary colic in identifying the disease, then patients need to follow a strict diet. They should carefully monitor their weight and drink enough liquid (1.5 - 2 liters per day). To avoid the risk of movement of stones on the bile ducts, patients should avoid doing work that requires a long stay in an inclined position.
Forecasts regarding the development of gallstone disease for all patients are different, since they directly depend on the rate of formation of stones, their size and mobility. In most cases, the presence of stones in the gallbladder leads to a number of adverse and severe complications. But if surgical intervention is performed in a timely manner, the dangerous consequences of the disease can be completely prevented!