Chololithiasis is a frequently diagnosed pathology, especially in people over 40 years of age. Gallstone disease affects mainly women, in men it occurs 5-10 times less often. If the disease is detected in time, you can get rid of concrements with conservative methods. In advanced cases, only surgical treatment will help.
Stones in the gallbladder - causes
The nature of the formation of concrements has not yet been clarified, only factors that increase the risk of their occurrence are known. It was found that cholelithiasis is extremely rare in children, its prevalence increases to reaching a mature and advanced age. Chololithiasis is 5-10 times more likely to progress in women, especially after 2-3 births or more.
Other presumptive causes that provoke gallstones:
- tendency to corpulence;
- eating foods rich in animal protein and fats;
- congenital anomalies and defects that hamper the excretion of bile;
- pathologies, accompanied by active decay of red blood cells;
- sedentary lifestyle;
- infectious diseases of the liver and gallbladder;
- absence of a diet;
- autoimmune conditions;
- hormonal imbalance;
- operations on the gastrointestinal tract;
- high cholesterol in the body and others.
Types of stones in the gallbladder
Before the appearance of solid structures, a biliary sludge is first formed. It is dense, like putty, bile. In the normal state, it is liquid, contains about 95% water. Of the biliary sludge gradually formed in the gall bladder. They have a different structure, shape and size (from a grain of sand to a chicken egg), depending on their chemical composition. Types of stones in the bile:
- cholesterol;
- calcareous;
- pigmented;
- mixed.
Classification by structure:
- fibrous;
- crystalline;
- amorphous;
- layered.
Differentiation of gallstones in form:
- faceted (multifaceted);
- spherical;
- barrel-shaped;
- helical;
- ovoid and others.
Cholesterol stones
This type of concrement is more common than others, in about 80% of cases. Such stones in bile consist mainly of cholesterol. Additionally, pigments and calcium salts (not more than 10-15%) can be included in their composition. Cholesterol does not dissolve in water and other organic liquids, so it circulates in conjunction with colloidal particles - micelles. When the metabolic processes are disturbed, these compounds precipitate out of which gallstones form in the gall bladder. At first they are small in size, like grains of sand, but gradually grow, tend to unite with each other.
Calcareous stones
This type of concrement is formed against the background of inflammatory processes. Calcareous stones in the gallbladder - the result of the deposition of calcium salts around accumulations of bacteria, small grains of cholesterol or epithelial cells. The most frequent causative agent of inflammation is the E. coli. Sometimes stones of lime in the gallbladder are formed due to hypercalcemia, with the progression of hyperparathyroidism. This is a very rare type of concrement.
Pigmented stones
The reason for the appearance of this variant of deposits is different forms of hemolytic anemia. The disease provokes violations of processing bilirubin, resulting in the formation of pigmented stones in the gallbladder. Often they occur again, in addition to other types of concrements (cholesterol or calcareous). In such cases, stones in the gallbladder are formed due to infectious processes. Inflammation can cause cholelithiasis itself, bacterial or viral lesions.
Mixed Stones
The type of concrements described is layered and large in size. Multiple mixed stones in the gallbladder are the result of the layering of calcium salts into cholesterol and bilirubin. The presence of such formations indicates a long course of pathology. Conservative therapy of mixed stones is rarely successful. More often the treatment involves removing the affected organ along with the calculi.
Stones in the gallbladder - symptoms
About 60-80% of patients with cholelithiasis do not feel any signs of pathology during the first 5-15 years of its development. For this reason, in the early stages it is almost impossible to detect stones in the bile - the symptoms are either absent or occur extremely rarely and quickly pass. This phenomenon is due to the stasis of the stones, unpleasant sensations they provoke only during movement on the ducts.
Sometimes stones in the gallbladder make themselves felt by the following clinical manifestations:
- bitter taste in the mouth;
- nausea;
- flatulence ;
- vomiting with bile ;
- violations of defecation;
- icterus of the skin and eyes;
- belching with air;
- malaise;
- slight increase in body temperature;
- discolored feces;
- attacks of stabbing or aching pain in the liver region;
- deterioration of appetite.
Stages of cholelithiasis
The severity of these signs depends on the duration of progression of the pathology and its severity. Stages of cholelithiasis:
- Pre-stone. The bile thickens, the biliary sludge is formed. It may contain inclusions of calcium salts and bilirubin, a cholesterol precipitate.
- Asymptomatic. The first stones are formed in the bile ducts and the bladder. They are few and they are small, so there are no signs of illness.
- Progressive. Concrements are large and numerous, a person often suffers colic attacks. At this stage, you can still remove the stones in the bile without surgery, the treatment is conducted in conservative ways.
- Complicated. Chololithiasis of the advanced stage, only surgical intervention is supposed. Concrements fill almost all the internal space of the organ.
Gallstone disease - diagnosis
The main method of detecting the disease is to perform ultrasound. If it is carried out by an experienced doctor, there is no need for additional activities. In other cases, auxiliary methods are prescribed, which allow to diagnose concrements in the gallbladder:
- CT scan;
- retrograde pancreatocholangiorentgenography;
- nuclear magnetic resonance.
Stones in the gallbladder - what to do?
There are only 2 treatment options for cholelithiasis. The choice of approach depends on what the structure, number and size of stones, which consist of stones in the gallbladder - the symptoms, treatment corresponds to the stage of pathology. Before the appearance of marked signs of the disease, it can be eliminated in conservative ways. In the presence of complications, surgical intervention is immediately prescribed.
Stone in the gallbladder - treatment without surgery
If there is no clinical picture, conservative therapy is selected individually. It helps stop the progression of the disease and prevent complicated calculous cholecystitis - the treatment provides for:
- diet compliance;
- correct diet;
- weight normalization;
- physical activity.
In parallel, a person should take drugs that dissolve stones in the gallbladder:
- Ursosan ;
- Henofalk;
- Ursofalk;
- Genohol;
- Ursohol;
- Henosan;
- Ursofalk and analogues.
During seizures (colic), the appropriate therapy regimen is prescribed:
- Hunger, until the vomiting is over.
- Applying ice or cold compress to the right hypochondrium.
- Pain relief with spasmolytics (No-Shpa, Platifillin, Papaverin) and analgesics (Maxigan, Ibuprofen, Nimesil).
- Reception of antibiotics. They are selected only by a doctor if there is an infection.
- Detoxification - Enterosgel, Atoxil.
- Acceleration of the withdrawal of fluid from the body with the help of diuretics (Ureit, Lasix and others).
When the size of the stones in the gallbladder does not exceed 2 cm in diameter, and the concrements are small, shock wave lithotripsy is recommended. This is a way to break solid structures from the outside, it is used only in the absence of inflammatory processes. For manipulation, the contractility of the affected organ should be within the normal range, at least 75%.
Stones in the gallbladder - operation
Surgical intervention is called cholecystectomy. It is performed by laparoscopic method with minimal traumatization and short rehabilitation period (up to 3 days). This is not the removal of stones from the bile, but the excision of the bladder from the cervix along with the concrements. The effectiveness of such an operation reaches 99%, the procedure is effective even in advanced cases of cholelithiasis.
Cholecystolithotomy or removal of stones from the gallbladder separately, with the preservation of the organ, is unacceptable. Attempts to implement this option of surgical intervention ended in the 60's. Such operations are dangerous and traumatic, with serious consequences. Later, relapses occur, and a person still has to make a cholecystectomy.
Diet with stones in the gallbladder
At any stage of cholelithiasis, an important component of therapy is the diet. If there are no colic and single small stones in the gallbladder are found, the treatment presumes compliance with the Pevzner Diet # 5. Take food 4-6 times a day, at regular intervals. On an empty stomach it is recommended to drink cool clean water. In the period of colic, short-term fasting is prescribed with a gradual transition to diet No. 5a. The same diet is made when calculous cholecystitis progresses with inflammation. Proper nutrition should be lifelong, without bias.