Cholelithiasis or cholelithiasis is a pathology characterized by the formation of stones in the gallbladder and ducts. This is due to problems in cholesterol metabolism and the production of bilirubin.
Stones can be in large quantities, and they look like dense stones. The size of the stones varies from a few millimeters to a couple of centimeters, the shape is round (typical for the gallbladder) and oblong (for the ducts). In the ducts of the liver, stones can acquire a branched shape. Depending on the composition, the calculi are divided into pigment, mixed, cholesterol and calcareous.
Who is affected
Cholelithiasis is a fairly common pathology. Among all registered diseases of a chronic nature, this disease is in 3rd place, second only to cardiac and vascular pathologies, as well as diabetes mellitus.
Basically, cholelithiasis is typical for elderly people over 70 years old (approximately 45%). At the same time, this pathology is detected in women five times more often than in men. Children are diagnosed with this disease very rarely.
How disease occurs
Stones are formed in the gallbladder in two ways: inflammatory and metabolic. Due to nutritional problems and some pathological processes in the body, the level of cholesterol and bile acids changes. The composition of bile becomes atypical, it is also called lithogenic. Its composition can precipitate and transform into crystals, thus forming cholesterol stones.
The inflammatory process of stone formation occurs due to the development of liver diseases, in particular with jaundice. In this case, bilirubin is deposited, which leads to the formation of stones in the gallbladder.
Inflammation of the gallbladder, which is infectious or reactive, can also cause bile chemistry to become more acidic. As a result, there are fewer protein fractions, and bilirubin begins to crystallize. Layering of mucous secretions, epithelial cells, lime impurities leads to the formation and increase of stones. Cholelithiasis is a combination of all of the above factors.
Causes of disease development
Among the main factors that provoke the development of gallstone disease, it is worth highlighting the following:
- too much cholesterol released into the blood;
- changes in the composition of bile, the formation of lithogenic bile, which contains an excess amount of fat;
- allocation of a reduced amountphospholipids;
- violation of bile flow, that is, cholestasis;
- development of infectious diseases in the biliary tract.
Diseases that can trigger the development of cholelithiasis are:
- diabetes mellitus;
- anemia and other blood diseases;
- gout;
- problems with metabolism (protein, lipid, s alt);
- cirrhosis, hepatitis;
- disorders of a neuroendocrine nature, including dysfunction of the parathyroid and thyroid glands;
- toxic liver disease;
- inflammation of the gallbladder;
- congenital abnormalities and diseases of the abdominal organs, such as stenosis, bile duct cyst, etc.;
- parasitic diseases;
- oncological tumors of internal organs.
Factors that can provoke pathology
These factors include:
- menu consisting mainly of fatty animal products;
- predisposition to diseases of the gallbladder and liver;
- lack of dietary fiber;
- sedentary and sedentary lifestyle;
- obesity;
- old age, female;
- repeated births;
- fast weight loss;
- pregnancy;
- long-term parenteral nutrition;
- hormonal contraceptives.
Clinical picture
It is important to know that from the moment the formation of calculi begins to the first symptoms of cholelithiasis, it may passa couple of years.
Main symptoms of gallstone disease:
- jaundice;
- pain in the back, in particular in the area of the right shoulder blade;
- pain in the right hypochondrium, in the epigastric region;
- increased pain after eating fatty foods;
- sometimes nausea and vomiting;
- general malaise, weakness;
- regular loose stools;
- belching after eating;
- feeling of heaviness in the epigastrium;
- urine turns dark;
- in some cases, itching of the skin begins.
Stages of the disease
During the period of active development, cholelithiasis goes through the following stages:
- Latent, in which the disease is just beginning and does not show any symptoms.
- Dyspeptic chronic, which is characterized by minor pain, a feeling of heaviness in the area of the gallbladder and stomach, sometimes there are attacks of nausea and heartburn. Already at this stage, treatment of cholelithiasis is required.
- Painful chronic recurrent - characterized by periodic bouts of colic.
- Angina, which manifests itself in the form of heart pain. May occur even after the first stage and flow into the third.
- Saint's triad is a rare type of pathology, which, in addition to cholelithiasis, is also accompanied by diaphragmatic hernia and diverticula of the large intestine.
Complications and consequences
Gallstones not only cause dysfunctionof this organ, but also to damage to others. Therefore, it is important to seek medical help in a timely manner to determine the symptoms and treat cholelithiasis.
Acute inflammation occurs when stones clog the ducts. As a result, their walls swell. Ulcers, fistulas, hernias appear, even a rupture is possible. Complications such as peritonitis, toxic shock, cardiac, renal and hepatic insufficiency pose a serious danger.
A very common complication of gallstone disease is intestinal obstruction and bleeding from the colon. As soon as cholelithiasis is complicated by infectious inflammatory processes, jaundice, cholangitis, fatty hepatosis, cholecystitis, pancreatitis may appear. Of the serious consequences of gallstone disease, it is worth noting dropsy and empyema of the gallbladder, cirrhosis of the liver, abscess and cancer of the gallbladder.
History plays an important role in determining cholelithiasis. To make an accurate diagnosis, immediately contact a general practitioner, gastroenterologist and hepatologist. An experienced specialist is familiar with all the features of the symptoms and treatment of cholelithiasis in adults. He will make an accurate diagnosis and prescribe therapy.
Diagnostic measures
Treatment of cholelithiasis in the clinic begins with a diagnosis, which consists of several stages:
1. Laboratory diagnostics:
- blood test for bilirubin, transaminase and leukocyte levels;
- study of microscopic and biochemical bile types.
2. Methodsdiagnostic tools:
- duodenal sounding;
- abdominal X-ray and cholecystography intravenously, orally or by infusion;
- in the acute form of the disease, when surgery is needed, they resort to cholangiography, laparoscopic cholecystography or choledochoscopy during surgery;
- ultrasound, computed tomography, magnetic resonance imaging or radioisotope diagnosis of the gallbladder.
Differential diagnosis is carried out for hepatitis, duodenal ulcer, pancreatitis, appendicitis and oncology of internal organs, as well as for urolithiasis.
Treatment
The course of treatment directly depends on the stage of the disease, the size and number of stones, as well as their nature. At the onset of cholelithiasis, when the symptoms are mild, they resort to the following therapy:
- regular and long-term follow-up in the hospital, ultrasound examination of the gallbladder;
- following a special diet.
If the disease is already accompanied by regular bouts of colic, the patient is admitted to the hospital, where the following treatments are used:
- Elimination of painful symptoms. For this, analgesic drugs are used: No-shpa, Baralgin in the form of injections, Papaverine. The use of opioid analgesics is strictly prohibited, as they can cause spasms of the bile ducts.
- If positive resultsabsent, resort to pararenal novocaine blockade.
- If the patient has a fever, antipyretic drugs are indicated, for example, Paracetamol, Aspirin.
- If there are no inflammatory processes, you can resort to warming measures in the pain zone.
- After acute attacks have been eliminated, UHF, mud and mineral baths, as well as microcurrent therapy are prescribed.
- In cholelithiasis, choleretic drugs are prohibited, because this leads to a serious and dangerous movement of stones.
Treatment of large lesions
If the calculi do not exceed two centimeters and are of a cholesterol nature, methods of their dissolution are used. These include the use of special cholelitholytic drugs:
- chenodeoxycholic acid (the course of treatment is a whole year, the dose is increased periodically);
- ursodeoxycholic acid (expanded for two years);
- means containing immortelle sandy, if the disease is diagnosed at an early stage and the size of the stones is small.
Also, to dissolve stones, they resort to the introduction of methyl tert-butyl ether directly into the lumen between the bile ducts or into the lumen of the gallbladder.
Extracorporeal shock wave lithotripsy is used as a hardware method for removing calculi. The same method is used to eliminate small cholesterol stones in order to preserve the functions of the gallbladder. However, thisthe method has a large number of contraindications.
If the stone is one, but large, laparoscopic cholecystectomy is used, that is, excision of the gallbladder with stones. If many large stones have formed in the bladder, an abdominal operation is performed, the organ is removed and the ducts are drained. Now that you know what this disease is - cholelithiasis, you understand its seriousness.
