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Gallstones: symptoms, treatment without surgery


Today, gallstone disease is one of the most common somatic diseases, ranking third after cardiovascular and endocrine pathologies. This multifactorial disease occurs due to a violation of the mechanism of the exchange of bile components (cholesterol and bilirubin) and causes the formation of stones in the gallbladder or bile ducts. What to do when the first symptoms of gallstones? Is it possible to dissolve the stones in the gallbladder and do without surgery? Answers you will learn from this article.

Causes of Gallstones

A necessary condition for the development of the pathological process and the subsequent formation of calculi is the simultaneous presence of three main factors: the production of lithogenic bile (supersaturated cholesterol), an imbalance between the activity of penetrating and anti-nucleating components and a decrease in the contractile function of the gallbladder.

To provoke the development of the pathological process can:

  • genetic predisposition;
  • food intake with high cholesterol and a small amount of plant fiber;
  • inflammatory processes in the biliary tract;
  • obesity;
  • biliary dyskinesia ;
  • use of oral contraceptives;
  • taking estrogen, clofibrate, sandostatin and some other drugs;
  • Crohn's disease;
  • total and subtotal hemicolectomy;
  • impaired absorption syndrome;
  • severe weight loss;
  • flatulence;
  • pregnancy;
  • chronic and xanthogranulomatous cholecystitis ;
  • gallbladder cholesterosis

The mechanism of development of gallstone disease

In clinical practice, two main mechanisms of stone formation are considered: vesicouplasmid and hepatic-exchange.

In the first case, the cause of the formation of stones in the gallbladder becomes an inflammatory process, leading to a change in the pH of the bile in the acidic direction. As a result, the protective properties of the protein fractions are reduced, and crystallization of bilirubin occurs with the formation of the primary crystallization center, around which other components of bile, mucus and epithelium subsequently begin to layer, forming a calculus.

Hepatic-metabolic mechanism of gallstone disease is a consequence of:

  • unbalanced nutrition (coarse fats (mutton, pork, beef) prevail in the diet);
  • endocrine disorders;
  • hypothyroidism;
  • infectious-toxic lesions of the hepatic parenchyma; hypodynamia;
  • age disorders.

The formation of gallstones is a fairly long process. The disease develops gradually, over several years, characterized by a polymorphic symptomatic picture. During the year, stones grow by 3-5 mm (in some cases, their growth may increase).

Types of gallstones

  1. Cholesterol stones.

Presented in the form of X-ray negative homogeneous formations of a rounded shape, 15-18 mm in diameter, arising as a result of disruption of metabolic processes. Most often they are found in obese patients, in the absence of inflammation, directly in the gallbladder.

  1. Bilirubin (pigment) stones.

The formation of these stones also occurs without the participation of inflammatory mechanisms. They occur when changing the protein composition of the blood and with various congenital abnormalities, accompanied by increased breakdown of red blood cells. Bilirubin stones are multiple formations of relatively small size, localized in the gallbladder and bile ducts.

  1. Limestone stones.

The basis of calcareous stones is calcium. These are quite rare calculi resulting from the development of inflammation in the walls of the gallbladder. In this case, the center of formation, around which calcium salts begin to be deposited, becomes bacteria, small crystals of cholesterol, or pieces of desquamated epithelium.

  1. Gallstones mixed composition.

As the inflammation increases, calcinates become layered on pigment and cholesterol stones, turning them into concrements of a mixed composition with a characteristic layered structure. As a rule, such formations cause the surgical intervention.

Classification of gallstone disease

Gallstone disease is a multi-stage disease. According to the classification of JCB, adopted in 2002, it is customary to distinguish 4 stages of stone formation:

I (pre-stone) stage.

At this stage, thick non-uniform bile or biliary sludge is formed (an accumulation of crystals of bilirubin, cholesterol and calcium salts);

II st. - stage of formation of stones.

Stones can form directly in the gallbladder, common gall, or in the hepatic ducts. They are single or multiple and different in composition.

III Art. - development of chronic recurrent calculous cholecystitis;

IV art. - complications of the disease.

Gallstones: symptoms

The clinical picture of the development of gallstone disease is quite diverse. Its manifestations depend on the composition, number and localization of stones. Most patients with single large stones located directly in the gallbladder, often unaware of their disease. This condition is called the latent (latent) form of JCB.

The most characteristic symptom of the disease is an attack of biliary colic, resulting from the release of the stone of their gallbladder and its advancement along the bile duct. In this situation, pain develops due to increased intravesical pressure and spastic contraction of the organ. She appears suddenly, but against the background of complete health. The focus is the region of the right hypochondrium, whence pain may radiate under the scapula, neck, arm or epigastric region.

Most often, hepatic colic develops after the consumption of fatty, spicy, fried foods, beer or carbonated drinks. However, it can be triggered by a strong psycho-emotional stress, carrying weights and driving on uneven terrain. As a rule, after the use of antispasmodic drugs and heat to the gallbladder area, the pain passes over time. Pain lasting more than 4 hours, signal the spread of the pathological process beyond the gallbladder.

As a result of bile throwing into the stomach, the patient has bitter taste in the mouth, heaviness in the epigastric region, nausea and vomiting develops. There may also be flatulence, diarrhea with a characteristic liquid, fetid stool, or constipation. Often there is intolerance to the milk diet.

Objective symptoms include jaundice, pain on palpation of the cystic points (with obesity and a highly located diaphragm, it is absent), the occurrence of brown or white plaque on the tongue.

At stage III of the disease (chronic calculous cholecystitis) a long subfebrile condition develops, as well as the formation of cholecystocardial syndrome (pain localized in the apex of the heart) is possible. They can be long, aching, and can be paroxysmal in nature. Often, patients with cholelithiasis, pain in the joints, which pass after the treatment of this disease. Observed changes in the composition of the blood (eosinophilia and neutrophilic leukocytosis). Many patients complain of intolerance to some products, possibly the development of neurasthenic syndrome.

Diagnosis of gallstone disease

Laboratory research methods

  1. Biochemical blood test (increased bilirubin level and serum aminotransferase activity).
  2. General clinical blood test (accelerated ESR and increased white blood cell count).

Instrumental research methods

  1. Ultrasound of the liver and gallbladder. The most informative technique, 95% allowing to diagnose stones in the choledochus and gall bladder.
  2. X-ray. In the overview picture of the abdominal cavity, calcareous stones (calcinates) are found.
  3. Endoscopic retrograde cholangiopancreatography. Allows you to identify calculi in the bile duct.
  4. Percutaneous transhepatic cholangiography.
  5. Cholecysto-cholangiography. Is carried out before laparoscopic surgery or when it is impossible to perform ERPG.
  6. Endoscopic ultrasonography. This study is carried out with flatulence, and is also shown to obese patients. Scanning is performed by means of an endoscope inserted through the stomach or intestine.

Gallstones: treatment without surgery

Conservative techniques

Conservative treatment of cholelithiasis is carried out at the initial (pre-stone) stage of the disease, and can also be administered to some patients with already formed calculi.

Pharmacotherapy includes taking hepabene or preparations of bile acids (when prescribing, the state of the contractile function of the gallbladder and the form of the biliary sludge is taken into account).

Litolytic therapy is prescribed to patients with already formed gallstones (urodexycholic acid preparations are used to dissolve bile salts). It should be noted that such treatment is recommended only if the patient does not agree to the operation, and other methods are contraindicated for him. The greatest effect of UDCA is observed in the early stages of stone formation. At the same time, during the long course of the disease, lithotic therapy, due to the removal of stones, is often ineffective. Experts recommend treatment with urodexycholic acid in the presence of stones, the size of which does not exceed 10 mm.

Contact (local) dissolution of stones

Contact litholysis is a technique involving the introduction into the gallbladder or bile ducts of a special organic solvent (methyl tertiary butyl ether or propionate). The effectiveness of this method is 90%, however, after the dissolution of the stones, the patient requires supportive therapy. With the help of contact litolysis in about 14-16 hours cholesterol stones of various sizes and quantities are completely dissolved.

Extracorporeal shock wave lithotripsy

Extracorporeal shock wave lithotripsy (pulverization) is a technique based on the generation of a shock wave, leading to the crushing of a stone into many grains of sand. Currently, this procedure is used as a preparatory stage before oral litholytic therapy.

The indication for ESWL is the absence of violation of the biliary tract, single and multiple cholesterol stones with a diameter of not more than 3 cm.

Surgical treatment of gallstone disease

When performing a surgical procedure, the gallbladder can be removed together with the stones in it, or only stones. Currently in surgical practice in the treatment of cholecystolithiasis, several types of operations are used:

  • classical (open) cholecystectomy (removal of the gallbladder);
  • laparoscopic cholecystectomy;
  • laparoscopic cholecystolithotomy (organ-preserving operation involving the removal of stones).

Prevention of stone recurrence

In order to prevent the re-formation of calculus within a few months, it is necessary to continue the litholytic therapy, avoid taking certain medications, reduce body weight by refusing cholesterol-rich foods and avoid long periods of fasting.

Possible complications of gallstone disease

  • Acute and chronic cholecystitis;
  • Dropsy of the gallbladder;
  • Cellulitis of the gallbladder wall;
  • Acute purulent inflammation (empyema) and gangrene of the gallbladder;
  • Perforation of the gallbladder;
  • Biliary pancreatitis ;
  • Intestinal obstruction;
  • Bile fistula;
  • Miritsi syndrome (compression of the common bile duct);
  • Cancer of the gallbladder.

| 29 May 2015 | | 12,093 | Surgery
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