Gallstone disease (cholelithiasis or, as it is incorrectly called cholelithiasis) is a disease associated with impaired cholesterol and bilirubin metabolism, resulting in the formation of stones (stones) in the gallbladder (cholecystolithiasis) and / or in the bile ducts (choledocholithiasis).
This disease is most common in third place after cardiovascular disease and diabetes. It is more common in economically developed countries in individuals whose work is associated with stressful situations and leading a sedentary lifestyle.
How gallstones are formed
The gallbladder is a reservoir for bile produced by the liver. The movement of bile along the biliary tract is provided by the coordinated activity of the liver, gallbladder, common bile duct, pancreas, duodenum. This ensures the timely flow of bile into the intestine during digestion and its accumulation in the gall bladder on an empty stomach.
The formation of stones in it occurs due to changes in the composition and stagnation of bile (dyscholium), inflammatory processes, motor-tonic disorders of biliary excretion (dyskinesia).
There are cholesterol (up to 80-90% of all gallstones), pigment and mixed stones.
The formation of cholesterol stones contributes to the glut of bile cholesterol, its precipitation, the formation of cholesterol crystals. With impaired motility of the gallbladder, the crystals do not appear in the intestine, but remain and begin to grow.
Pigment (bilirubin) stones appear as a result of enhanced erythrocyte breakdown in hemolytic anemia.
Mixed stones are a combination of both forms. They contain calcium, bilirubin, cholesterol.
Occur mainly in inflammatory diseases of the gallbladder and biliary tract.
Causes of gallstone disease
1. Inflammation of the biliary tract (cholecystitis, cholangitis).
Infection plays a role in the formation of calculi. Bacteria are capable of converting bilirubin, soluble in water, into insoluble, which precipitates.
2. Endocrine disorders:
- hypothyroidism (insufficient secretion of thyroid hormones),
- Estrogen metabolism, in various gynecological diseases, hormonal contraceptive use, pregnancy.
There is a violation of the contractile function of the gallbladder, the stagnation of bile.
3. Disruption of cholesterol metabolism:
With increasing cholesterol, conditions are created for the formation of stones.
4. Hyperbilirubinemia - an increase in the level of bilirubin with an increase in its content in the bile:
- hemolytic anemia.
5. Hereditary predisposition.
6. Fasting, irregular nutrition cause a violation of the normal function of the gallbladder.
7. Excessive consumption of animal-rich cholesterol foods. This contributes to a shift in the reaction of bile to the acidic side, which leads to the formation of stones.
Symptoms of gallstone disease
For a long time, the disease may be asymptomatic and become a finding with ultrasound. With the migration of stones, the accession of infection in the gallbladder and ducts symptoms appear. Symptoms of cholelithiasis depend on the location of the stones, their size, activity of inflammation, as well as damage to other digestive organs.
When the stones come out of the gallbladder and move them along the bile ducts, an attack of biliary colic occurs. They provoke an attack of error in the diet, especially the abuse of fatty foods, vibration, stressful situations. Sudden pain, sharp in the upper abdomen, in the area of the right hypochondrium, gives to the right shoulder blade, the right shoulder. Often the pain in cholelithiasis is accompanied by nausea, vomiting, not bringing relief, dry mouth. Disturbed itchy skin.
Perhaps the appearance of jaundice of the sclera and skin, darkening of the urine and discoloration of feces.
The duration of pain from a few minutes to several hours, the pain subsides on its own or after anesthesia.
Symptoms of biliary colic do not always have the classic variant of manifestation, they can often resemble other diseases: right-sided pneumonia, acute appendicitis, especially when it is not typical, liver abscess, renal colic - in urolithiasis, acute pancreatitis.
Cholecystocardiac syndrome may occur when pain in the heart is the only symptom of gallstone disease.
To establish an accurate diagnosis, when the first signs of the disease appear, an urgent need to consult a general practitioner, a family doctor.
Instrumental diagnostic methods.
1. Ultrasonography of the abdominal organs is the main and most effective method for the diagnosis of cholelithiasis. Detects the presence of gallstones, thickening of the walls of the gallbladder, its deformation, expansion of the bile ducts.
Its main advantages are non-invasiveness (non-invasiveness), safety, accessibility and the possibility of multiple holding.
2. X-ray examination of the abdominal cavity - to identify X-positive carbonate stones.
3. Endoscopic retrograde cholangiopancreatography (with suspected presence of stones in the bile ducts).
4. In controversial cases, magnetic resonance cholangiography is used, it allows you to accurately assess the condition of the biliary tract through two-and three-dimensional images, computed tomography.
1. Total bilirubin and its fractions, transaminases. Examine to assess the functional state of the liver.
2. Lipidogram. Determine the level of cholesterol, triglycerides. With their increase, it is necessary to conduct therapy aimed at reducing these indicators, for the prevention of stone formation.
Inspection of the surgeon is required - to select the treatment tactics.
Drug treatment of gallstone disease
The conservative method is used in the presence of cholesterol gallstones (X-ray negative) with a size of up to 15 mm with the contractility of the gallbladder preserved and the patency of the cystic duct.
Contraindications for medical dissolution of gallstones:
- acute inflammatory diseases of the gallbladder and biliary tract,
- stones with a diameter of more than 2 cm,
- liver diseases, diabetes mellitus, gastric ulcer and duodenal ulcer, chronic pancreatitis,
- inflammatory diseases of the small and large intestine,
- "disabled" - non-functioning gallbladder,
- pigment or carbonate stones,
- cancer of the gallbladder,
- Multiple stones that occupy more than 50% of the volume of the gallbladder.
Ursodeoxycholic acid preparations are used, the action of which is aimed at dissolving only cholesterol stones; the drug is taken for 6-24 months. But the probability of a relapse after the stones dissolve is 50%. The dose of the drug, the duration of the reception is established only by a physician or a gastroenterologist. Conservative treatment is possible only under medical supervision.
Shockwave cholelitis - treatment by crushing large stones into small fragments using shock waves, followed by bile acid preparations (ursodeoxycholic acid). The probability of recurrence is 30%.
Gallstone disease for a long time may be asymptomatic or malosimptomno, which creates certain difficulties of its detection in the early stages. This is the cause of late diagnosis, at the stage of already formed gallstones, when the use of conservative treatment methods is limited, and the only treatment method remains surgical.
Principles of diet with joint disease
The combination of GCB and pancreatitis requires adhering to rather strict nutritional guidelines:
- exclusion from the menu of foods containing large amounts of cholesterol,
- minimizing the concentration of bile,
- the selection of products containing a fairly large amount of magnesium salts and unsaturated fatty acids, in order to remove excess cholesterol,
- increasing the share of fresh vegetables on the menu,
- replacement of all methods of heat treatment of products with one - steaming.
Meals should be fractional - food should be taken up to 6 times a day, but in small portions. Fluid intake should be increased to at least 2 liters per day.
How gallstones causes pancreatitis
The combined ducts of the organs constantly interact with each other, therefore, when the ICB stone is pushed out of the gallbladder, passing the duct of the bladder and the common bile duct, "stalls" where they merge and flow into the intestine. This pathology in case of JCB disease occurs most often and is explained by the fact that the area of the Vateri nipple (where the ducts enter the intestine) is the narrowest in patency in all biliary tract.
The pancreas and liver produce secretions and bile. During exacerbation of the GCB, both fluids entering the canals do not find an outlet to the intestine - it was blocked by a stone. The pressure in the ducts increases, which leads to rupture. Content enters the pancreatic tissue. Enzymes that break down carbohydrates, fats and proteins, while in the duct - are inactive. But when the gland cells break, the enzymes are activated, triggering the process of self-digestion of the organ, which causes an attack of acute pancreatitis or pancreatic necrosis - the most dangerous disease for a person's life.
This is the mechanism of development of pancreatitis, observed in gallstone disease, caused by gallbladder stones that blocked the duct. Doctors for the prevention of pancreatitis and pancreatic necrosis urge patients to promptly, promptly remove stones from the gallbladder and be careful when taking choleretic charges and drugs having such a diagnosis. After all, it is impossible to predict how the stone will react to “persecution”, whether it will be able to slip into the duodenum without getting stuck on the road, causing an attack of acute pancreatitis.
Diet and nutrition for gallstones and pancreatitis
For gallstone disease and pancreatitis, it is recommended to minimize the amount of consumed foods containing large amounts of cholesterol. Adjusting cholesterol metabolism in the body implies a reduction in caloric intake of food. Often, patients with this diagnosis must completely abandon products such as liver, fatty fish, egg yolk, and lard and animal fats. At the same time, the diet of the patient with gallstones and pancreatitis should contain foods rich in magnesium salts. This element promotes the excretion of cholesterol, which provokes the aggravation of JCB.
In order to prevent attacks of JCB, you need a diet that allows you to constantly maintain the cholesterol contained in bile in a dissolved state. A diet that includes alkaline mineral water and plant foods, leads to an increase in alkali in the bile, and, as a result, the dissolution of cholesterol. It is important to note that for a speedy recovery to a patient with gallstone disease and pancreatitis, it is important to eat a large amount of vegetables, and also to cook only steam, baked and boiled dishes.
Characteristic symptoms of the disease
Gallstone disease (ICD) is a disease of the gastrointestinal tract, characterized by the formation and growth of hard stones in the gallbladder. The disease proceeds in three stages:
- Physico-chemical. At the first stage, processes predict the formation of stones. In bile, the level of cholesterol rises.
- Latent. Symptoms of a stage are not shown, similarly to the first. But the stones are already present in the bladder, irritate the mucous membrane, scratch. In the gallbladder and ducts, the inflammatory process begins.
- Clinical. At the stage, the symptoms of the disease taken for seizures are fully manifested.
Stones formed in the organ during the course of the disease fall into the bile ducts and can clog them. What is happening causes complications in the gallbladder. The patient has biliary colic, called an attack of JCB.
The key to normal functioning of the digestive tract becomes proper nutrition. Stones in the gallbladder are formed when a metabolic disorder or an infection is ingested. The causes of disease are many. Doctors studying violations arising in the gastrointestinal tract, identified certain risk factors. The presence of factors often causes the appearance of the disease:
- Sedentary lifestyle.
- Genetic predisposition.
- Wrong lifestyle, drinking alcohol.
- Eating disorders, fasting, obesity.
- Diseases of the gastrointestinal tract.
The disease often manifests itself in women during pregnancy. Due to the factors accompanying the expectation of a child, the level of cholesterol, the main component of the stones, increases. The process contributes to the stagnation of bile in the bladder. The probability of the disease increases if you drink hormones.
Symptoms of the disease
The first two stages of the disease are asymptomatic. The patient does not know that he becomes a carrier of gallstones. Symptoms occur when the stone enters the bile duct. The first signs of violations are bitterness in the mouth, pain in the right hypochondrium, heaviness. Nausea, flatulence, belching.
Stone of small size is able to pass through the ducts directly into the duodenum. Then the formation leaves the body along with feces. In such cases, the attack passes on its own, without treatment.
If the stone is large, this is a sure sign of the danger of being stuck in the ducts. Similar threatens with severe complications requiring treatment. If the duct is blocked, the pain does not go away, it is indicated to immediately consult a doctor. With exacerbation of the ICD, inflammation of the gallbladder occurs. Without treatment, a patient develops third-party gastrointestinal diseases:
- Acute pancreatitis.
- Obstructive jaundice.
- Liver abscess.
In order to avoid undesirable effects do not need to ignore the symptoms of the disease. It is important to start treatment on time. In the early stages of the disease, treatment increases the likelihood of complete recovery with the least amount of time and effort of the patient.
Diagnosis of the disease
Diagnosing and treating a patient with cholelithiasis is done by a gastroenterologist. The doctor collects history and visual examination, examines the patient's susceptibility to the disease. Accurate diagnosis is extremely important, early symptoms are similar to other diseases of the gastrointestinal tract, for example, gastritis and pancreatitis.
To clarify the diagnosis is assigned a number of additional studies, including laboratory and instrumental methods. The main method of instrumental diagnostics in the determination of the JCB is ultrasound.The method helps to determine the presence of stones, find out the size and location.
Based on the data obtained, the doctor establishes an accurate diagnosis. An important role in the diagnosis is the study of the patient's lifestyle, genetic predisposition. Observing a detailed picture of the course of the disease, the doctor prescribes a suitable treatment.
Depending on the degree of severity and severity, methods of treating cholelithiasis are determined. In the treatment of most diseases, doctors try to do with conservative methods. Surgical intervention can lead to undesirable consequences for the functioning of the human body. If the disease takes a severe form, therapeutic treatment does not bring results, the doctor decides to treat the disease with surgery.
Is it possible to do without surgery
Many patients question the possibility of effective treatment of the disease without surgery - and they are mistaken. The opportunity to do without the operation should take advantage. The doctor can assign the correct treatment method only after examining the patient’s medical history, taking into account possible factors and risks. Self-medication is dangerous.
Treatment of gallstone disease without surgery is prescribed if the size of the stones is up to three centimeters. Gastrointestinal disorders have been adequately studied by gastroenterologists. Based on the research, a number of treatments have been developed. Diet, as a means of treatment, is widely used as part of the methods, speaking also a complete method of treatment of JCB.
Treatment without surgery
Therapeutic treatments include drug therapy and lithotripsy. An important role is played by adhering to a strict diet. The sanatorium treatment is recognized as a positive way to cure the disease. Not all patients have the opportunity to use the method mentioned.
The conditions of the spa treatment help to provide the patient with a regimen aimed at normalizing the work of the gastrointestinal tract. A similar technique is used for patients with diagnoses: gastritis, gastric ulcer, chronic pancreatitis. An important role is played by the climatic conditions assigned to the patient's regular walks. This is aimed at enhancing the activity of the patient. The patient takes mineral water, keeps to a diet. For people suffering from disorders in the gastrointestinal tract, a special menu is drawn up. The patient is assigned mineral baths and physiotherapy.
The main task of treatment is the release of the gallbladder and ducts from the stones, an important role is given to lithotripsy. The term refers to the procedure of contactless crushing of stones in order to independently pass formations through the ducts. The method is used for stones in the gallbladder to three centimeters. The danger of the procedure is due to the possibility of duct blockage by passing crushed stones. Along with lithotripsy prescribed drugs that contribute to the dissolution of stones. For patients prescribed drugs ursodeoxycholic acid.
The doctor controls the treatment method with ultrasound. Additionally introduced the use of herbal medicine. The attending physician corrects nutrition in case of cholelithiasis. Changing lifestyle with GCS is the main component of effective non-surgical treatment.
Diet for cholelithiasis
For full recovery, the patient will need to change lifestyle. Compliance with the individual rules of nutrition is important for cholelithiasis. It does not matter whether surgery was performed or treatment was prescribed without surgery, diet plays a huge role in the healing process. Known list of popular diets for patients with JCB, a common and effective from the list - №5.
Features of the fifth table
M.I. Pevzner, the founder of the national diet, in 1929, developed a method of diet. Based on the methods, a table of medical tables was created. The approach of a scientist in nutrition is widely used in sanatorium treatment. Total diets fifteen. For patients with impaired gallbladder, diet No. 5 is recommended. The patient is prescribed a diet by the attending physician, determining the compliance period. Follow the diet shown at home, after studying the permissible food and cooking rules.
The diet is aimed at a normal amount of protein and carbohydrate intake, with a noticeable decrease in fat intake. The energy value of the diet does not exceed 2500 kcal per day. A similar diet is prescribed for patients with a diagnosis of chronic pancreatitis, gastritis, and liver problems.
The patient is assigned a fractional power. It is recommended to take food in small doses, without loading the digestive system. Meals five to six a day. An important element in the diet is the processing of food. Food is recommended to use chopped or wiped form. This prevents the production of excess bile, reduces the likelihood of colic.
Products should not be fried or smoked. It is advisable to cook dishes for a couple, boil. It is permissible to bake or stew dishes. It is shown to eat at least salt (10 grams). Daily consumption of simple purified water is increased to two or more liters per day.
What can and can not
The patient will have to completely adjust the menu. You will need to examine the list of products to exclude from the diet. Alcohol can cause spasms of the bladder and ducts, causing colic. Removes products that overload the liver and gallbladder, contributing to the production of bile and gas formation. From the menu, remove foods that irritate the digestive tract, overloading the human digestive system. Prohibited to use:
- Pastry baking.
- Fatty dairy products.
- Cabbage, beans.
- Smoked, salted, fatty fish.
- Fat meat, sausages.
- Coffee, strong tea.
- Spices, spices, onions, garlic.
The list is much longer. It includes products containing an abundance of animal fats, oils, smoked meats, spicy dishes. Strong tea for cholelithiasis is prohibited, it is permissible to drink tea with milk or lightly brewed beverages. As an analogue of tea use compotes, broth hips. A fiber-rich food that improves digestion, pectins that reduce inflammation, lipotropic substances that dissolve fats is recommended. Favorable effect on the body produce products containing magnesium, which removes the spasms of the gallbladder.
You need to eat foods:
- Rusks and bran bread.
- Lean meat
- Dietary vegetable soup.
- Low-fat and light-salted fish.
- Low-fat dairy products.
- Nuts, dried fruits and seeds.
- Vegetables containing pectin.
Fruit is allowed to eat pomegranates, bananas. Baked apples, jelly, marmalade are allowed. Seafood saturated with iodine helps to bind cholesterol. Vitamin D prevents salt deposits. Fish oil helps empty the gallbladder. Permitted product - cheese, but in limited use.
Compliance with the rules of the diet can beneficially affect the work of the gallbladder, the functioning of the body as a whole. Eating healthy foods improves the functioning of the gastrointestinal tract, preventing many diseases. Diet for cholelithiasis helps strengthen the immune system, improve overall health.
Traditional methods of treatment
In folk medicine, selected prescriptions have been developed, supported by qualified doctors. Many of the descriptions use beetroot. Vegetable is required to cut and cook to the consistency of syrup. Drink half or three times a glass of broth. Allowed to use beet juice, separately or with radish juice. It is believed that beets helps to dissolve the stones.
There is a huge amount of decoctions based on honey. Radish, horseradish, birch sap and other means are added to the recipes. Honey treatment has a choleretic effect, the product helps to improve digestion.
Various medicinal herbs are widely used in traditional medicine recipes. The healing effect has a decoction of celandine and mint. Add corn silk, sage, chamomile and other herbs. Often the broths need to be insisted and taken a tablespoon several times a day, baths are made with favorites, others drink like tea.
A known method of treatment and prevention of JCB kombucha. Japanese Kombucha contains acid that helps break down stones.
Homemade recipes are allowed to use only after consulting a doctor. Professional advice will help to avoid undesirable effects of self-treatment. Useful food is shown for the treatment and prevention of gallstone disease. Prepare without excessive use of spices and salt. It is important to exclude harmful, fatty foods that adversely affect the gastrointestinal tract.
Surgical treatment of gallstone disease
Patients should undergo a planned operation before the first attack of biliary colic or immediately after it. This is due to the fact that the risk of complications is high.
After surgical treatment, it is necessary to observe an individual dietary regimen (frequent, divided meals with the restriction or exclusion of individually intolerable foods, fatty, fried foods), adherence to work and rest, exercise. Eliminate the use of alcohol. Perhaps the spa treatment after surgery, subject to sustained remission.
Complications of gallstones.
When joining the infection develops acute cholecystitis, empyema (significant accumulation of pus), cholangitis (inflammation of the bile ducts), which in turn can lead to the development of peritonitis. The main symptoms are sharp, intense pain in the right hypochondrium, chills, fever, severe weakness, impaired consciousness.
Choledocholithiasis (stones in the bile duct) with the development of obstructive jaundice. After one of the attacks of biliary colic, itching appears, sclera jaundice and skin, discolored feces, dark urine.
With prolonged occlusion of the cystic duct and the absence of infection, the gall bladder drops down. The bile from the bladder is absorbed, but the mucous continues to produce mucus. An increase in the size of the bubble. Manifested by bouts of biliary colic, in the subsequent pain subsides, there is a heaviness in the right hypochondrium.
On the background of long-term gallstone disease, gallbladder cancer often occurs,
acute and chronic pancreatitis develops. With prolonged blockage of the intrahepatic bile ducts, secondary biliary cirrhosis develops. Large stones of the gallbladder practically do not migrate, but they can lead to the formation of a fistula between the gallbladder and the duodenum. As a result of stone falling out of the bladder, it begins to migrate and may lead to the development of intestinal obstruction.
Untimely removal of the gallbladder (cholecystectomy) is one of the reasons for the development of postcholecystectomy syndrome.
Complications are a threat to the life of the patient and require immediate inspection of the surgeon and hospitalization in the surgical hospital.
Prevention of gallstone disease.
Even after a successful operation in 10% of cases there are relapses. To prevent the development of new stones, a lifestyle change is necessary. Occupations in a gym, active recreation, promote bile outflow, liquidate its stagnation. It is necessary to gradually normalize body weight, this will reduce cholesterol hypersecretion.
Patients who are forced to take estrogen, clofibrate, ceftriaxone, octreotide for a long time must undergo an ultrasound examination in order to detect changes in the gallbladder in time. If you increase the level of cholesterol in the blood, they recommend taking statins.
Diet for gallstones
Limit or eliminate from the diet fatty, high-calorie, cholesterol-rich dishes, especially with hereditary susceptibility to gallstone disease. Food should be frequent (4-6 times a day), in small portions, which helps to reduce the stagnation of bile in the gall bladder. Food should contain a sufficient amount of dietary fiber, due to vegetables and fruits. You can add food bran (15g 2-3 times a day). This reduces the lithogenicity (tendency to stone formation) of bile.
Consultation of a doctor for gallstone disease
Question: how is it called a disease, cholelithiasis or cholelithiasis?
Answer: according to the international classification of diseases, the name "gallstone disease" does not exist, there is only cholelithiasis.
Question: What medicines, folk remedies, sanatorium-resort treatment remove stones from the gallbladder?
Answer: There are no such drugs. All choleretic agents for cholelithiasis should be taken strictly for the purpose and under the supervision of a physician. It is not safe to self-medicate in such a situation due to the high risk of complications. With planned cholecystectomy (surgery to remove the gallbladder), the mortality rate is 0.5%, and during cholecystectomy for acute cholecystitis (which is a complication of self-treatment), the mortality rate reaches 20%. Sanatorium treatment in the presence of gallstones is contraindicated.
Question: Should a patient be observed after surgery for cholelithiasis, which specialist, for how long, and with what drugs to carry out postoperative treatment?
Answer: Patients after surgical treatment are observed by a family doctor, a therapist. An annual physical examination, an ultrasound examination of the abdominal organs, lipidogram monitoring, and liver function tests are performed annually. Based on the data of examination, diagnostic studies, the doctor recommends a complex of necessary therapeutic and recreational measures to prevent the development of a relapse of the disease.
What foods need to be used in the diet?
The recommended diet when combining JCB and pancreatitis should include foods containing fiber, vitamin complexes, as well as magnesium salts. At the same time, food should be rubbed, and drinking should be heated. Such a diet provides:
- stimulation of intestinal motility,
- reduction of inflammation,
- weakening of spasms.
The table below shows exactly which products and in what form are permissible for people who have been diagnosed with cholelithiasis in combination with pancreatitis:
General information about the pathology
The appearance of stones in the pancreas is a rather rare pathology arising from the development of the chronic form of pancreatic disease and dramatic changes in the metabolic processes. Intensive deposition of calcium salts in the pancreatic cavity contributes to the formation of stones that block the release of enzyme components produced by the gland, which leads to their activation in the gland cavity and the development of a necrotic process against the background of the digestion of the organ itself.
Therefore, timely detection of stone formation in the parenchymal organ can not only give a positive result in treatment, but also adjust the digestive processes, improve the patient's quality of life and prevent the likelihood of death.
In addition to those stones that form in the pancreatic cavity, there are also those that can form in the cavity of the gallbladder, causing the development of gallstone disease.The formation of stones in the lumen of the gallbladder or in its ducts contributes to the development of the inflammatory process of the acute or chronic nature of the course, referred to as calculous cholecystitis.
The development of the acute form of calculous cholecystitis occurs due to the prolonged course of gallstone pathology, which, against the background of a long obstruction of the bile duct, causes the development of inflammation of the walls of the gallbladder. This is due to the fact that infectious microorganisms from other organs penetrate into its cavity while reducing the antiseptic properties of bile. At the same time, the development of an infection can cause a malfunction of the muscle membranes of the bladder itself or its ducts, causing dysfunction of the biliary tract.
The formation of stones in the pancreatic cavity does not occur in every patient with the development of gallstone disease, or chronic pancreatitis. Their mechanism of formation has not yet been thoroughly disclosed, but many experts identify a number of provoking factors, in the presence of which the probability of stone formation increases several times:
- elevated levels in the bile of a substance such as bilirubin,
- a large number of extra pounds,
- sedentary lifestyle,
- age indicator, usually stones begin to form in people older than 40-45 years,
- development of diabetes
- pathological changes in the functionality of the liver,
- genetic predisposition.
The formation of bilirubin, or as they are called cholesterol, gallstones occurs most often in the following categories of persons:
- in people with severe liver disease or blood,
- in girls older than 20-25 years, especially during pregnancy,
- have a strong half of humanity who are over 60-65 years old
- in the presence of a large amount of overweight,
- those who sit on a strict diet and lose a huge amount of kilograms in a short period of time,
- from taking contraceptives and reducing cholesterol in the blood, medicines.
Let us consider in more detail how cholelithiasis and inflammation of the pancreas are related.
As already mentioned, the pancreas and gallbladder are interconnected by being close to each other and performing similar functions. Indeed, the pancreatic duct of the gland flows into the same hole of the duodenum as the duct of the gallbladder in the area where the Vateri nipple is located. In most cases, both ducts merge into one and flow into one nipple opening, but there are cases when each duct flows into a separate duodenal opening, then the probability of interaction between the two ducts is maximally reduced.
At the confluence of two ducts, which happens in 75% of cases, and there is a complication in the form of exacerbation of pancreatitis.
The combined two ducts interact with each other on an ongoing basis. Therefore, when a stone is pushed out of the gallbladder cavity, it freely passes through the bile duct and gets stuck at the confluence of the ducts in the Vater nipple area, since this zone is the narrowest passageway into the intestinal cavity among all biliary tract.
The development of pancreatic enzymes by the pancreas and bile by the liver is maintained at the same level. Therefore, these fluids, passing through the ducts, do not have the opportunity to go into the intestine to participate in the digestive processes, since the passage to the intestine is closed with a stone. This leads to an increase in pressure in the ducts, which causes their rupture. All fluid contained in the ducts enters the pancreatic tissue.
Pancreatic juice, consisting of enzymes that break down proteins, fats and carbohydrates, while in the duct cavity, is not active. But when the walls of the duct rupture, it is activated, which causes intensive development of diffuse changes in the pancreas, the beginning of processes for digestion itself, the appearance of an attack of an acute form of pancreatitis or the development of such a serious and life-threatening pathology as pancreatonecrosis.
The main symptomatic manifestation, indicating that there are stones in the gallbladder, is a prolonged intense pain in the epigastric abdomen. Soreness can last from 5-10 minutes to a couple of hours with a gradual irradiation to the area between the shoulder blades and shoulder joint. In some cases, you may experience nausea and increased sweating.
Painful attacks with cholelithiasis may appear at intervals of a week, a month or even a year.
With the complication and blockage of the general passage into the intestinal cavity with a stone, the following symptomatic signs characteristic of the development of the acute form of pancreatic pathology in the pancreatic area appear:
- intense sharp pain in the area of epigastrium radiating to the back,
- increase the intensity of pain after eating,
- constant feeling of nausea, which in most cases ends with an intense discharge of vomit,
- fecal masses become light brown,
- the belly starts to grow in size,
- there is pain on palpation of the abdominal cavity.
Rupture of the bile duct leads to the spreading of the bile itself, which is manifested by yellowing of the skin, eyeball and the appearance of a feeling of itching all over the body.
Hospitalization of such patients is not a scour time, in order to eliminate the stone through surgical intervention and the normalization of the digestive processes in the body, as well as to restore the functionality of the bile ducts and pancreas.
Methods of diagnosis and elimination of pathology
To detect the presence of stones in the biliary ducts, pancreas and gall bladder, the following diagnostic measures are necessary:
- clinical study of blood tests
- X-ray of the bile ducts using endoscopic apparatus,
- CT scan
Stones in the pancreas and biliary ducts can be eliminated in several ways.
At small sizes of cholesterol stones, the method of their dissolution can be applied through the use of Ursodiol or Henodiol, which dilute the thickened bile with their destructive effect, dissolve and derive the data of education from the human body. They do not affect the digestive tract and have a high level of efficiency.
The next method of eliminating stones is to conduct a retrograde endoscopic cholangiopancreatography, during which the patient must swallow a long tube with a mini-camera attached at the end. This tube must pass through the pharynx into the stomach cavity to detect the presence of stones in the bile ducts, bladder and pancreas.
Stones of small size can be immediately removed using this device, but in the presence of large stony formations, a specialist makes a small incision in the area of the pancreatic muscle junction and the stone is pushed through into the cavity of the small intestine, from where it is naturally removed along with bowel movement.
It should be noted that the surgical treatment of this disease is a more invasive method of treatment, which until recently was considered the only true and most effective.
But the latest achievements of medical science allow, through remote removal of stones, by shock-wave lithotripsy not to resort to surgical intervention.
Shock-wave lithotripsy consists in directing sound waves to stones, which allows them to be ground into small pieces or to the state of sand, which are then naturally removed from the body. This method of treatment is possible only in an outpatient clinic, as the procedure involves the formulation of general anesthesia. Up to 2500-3000 wave hits have to go through the patient's body to crush the stone. The whole procedure can take from 40 to 60 minutes. Among the side effects may be pain in the abdominal area, as well as bruises on the skin.
Also, compliance with the dietary intake, which excludes the consumption of foods with a high concentration of cholesterol components and calories, is also appointed. But, it is necessary to enrich the daily menu with those foods that contain a sufficient amount of magnesium salts, which provide processes for removing excess cholesterol from the body, and have a prophylactic effect against the exacerbation of gallstone pathology.