One of the pathological conditions that are often diagnosed by gastroenterologists and require serious therapy is bile stasis. Symptoms of this syndrome indicate problems in the liver, which produces this substance, and the gallbladder, which is a reservoir for collecting bile.
Physiology
Before describing the symptoms of bile stasis and the treatment of this pathology, we should start with a brief anatomical digression.
It is known that after eating the fats that enter our body are broken down, but in order for all lipids to be emulsified and all vitamins to be absorbed, in addition to gastric juice and enzymes produced by the pancreas, acids and s alts are required - the main components bile. They enter the duodenum from the gallbladder, where the digestive process and fat hydrolysis continue.
What is the danger
If the bile stagnates and does not enter the intestinal section in a timely manner, then:
- Significantly reduced enzyme activity, which preventscomplete breakdown of fats. Lipids in excessive amounts enter the bloodstream, preventing the conversion of glucose into glycogen, which, in turn, is fraught with the development of diabetes.
- With symptoms of stagnation of bile in the gallbladder, there is a danger of accumulation of excess cholesterol, which is present in the bile itself. The result of this violation is hypercholesterolemia and the progressive development of atherosclerosis.
- Without proper treatment, bile stasis, the symptoms of which are detailed in the next section, leads to secondary cholecystitis or gallstone disease.
Often, in patients with bile stasis, inflammation of the gastric mucosa is diagnosed, since the digestive tract is regularly exposed to the active effects of acids that enter the esophagus back from the duodenum. Most often this happens with chronic duodenogastric reflux, which occurs when the cardiac sphincter is weakened. Symptoms of bile stasis can also signal bile duct fibrosis, which doctors call sclerosing cholangitis.
When there is a malfunction in the circulation of bile acids, not only the absorption of fats worsens, but also vitamins, which by their nature are fat-soluble substances:
- retinol (vitamin A);
- ergocalciferol (vitamin D);
- tocopherol (vitamin E);
- phylloquinone (vitamin K).
Vitamin deficiency can lead to various he alth problems. For example, with a lack of retinoltwilight vision worsens, a small amount of vitamin K threatens to reduce blood clotting, and a deficiency of vitamin D entering the body leads to osteomalacia - a decrease in mineralization and softening of bone tissue. In addition, hypovitaminosis interferes with the absorption of calcium, which makes it looser and is an excellent condition for the development of osteoporosis.
Another potential threat reported by symptoms of bile stasis is an increase in intestinal acidity. In a he althy person, bile, which contains calcium cations, reduces the acidity of the contents of the stomach, but with cholestasis, an acid-base imbalance of the gastrointestinal tract occurs, as a result of which ascites may develop.
At the initial stages of the development of cholestasis, any clinical manifestations are very rare. The sequence of occurrence of signs of the disease and their intensity largely depend on the cause and characteristics of the hepatobiliary system of the body in a particular case.
Characteristic manifestations
Common symptoms of bile stasis in the gallbladder for most patients are itching and discoloration of the feces. It is believed that the epidermis itches with cholestasis due to an increase in the concentration of bile acids in the blood. They enter the blood plasma due to damage to hepatocytes by chenodeoxycholic acid. Feces in this syndrome acquire a characteristic discoloration as a result of a deficiency of bilirubin, a bile pigment, which in a he althy person is oxidized to stercobilin and stains feces dark and urine light yellow. With stagnation of bile urinealso changes shade, becoming darker, as the amount of urobilin in its composition increases.
Typical symptoms of bile stasis in the liver are dyspeptic disorders. Diarrhea, constipation, constant nausea are manifestations characteristic of this condition. Since bile acids are of no small importance for intestinal motility, their lack leads to constipation. The cause of diarrhea, on the other hand, is an increased content of undigested lipids in the feces or a bacterial imbalance in the intestinal lumen.
Among the common symptoms of bile stasis, it is worth noting pain localized in the right hypochondrium, upper quadrant of the abdomen. The pains are dull paroxysmal in nature, can radiate to the upper back of the body, giving to the collarbone, shoulder or shoulder blade.
In addition, with cholestasis, patients experience frequent dizziness, feel weak. Due to the stagnation of bile, the liver increases in size, the pressure in the portal vein increases. In advanced stages of the disease, accompanied by cholestasis, hair loss (alopecia) is possible as a result of triglyceride deficiency.
Uncommon symptoms of bile stasis
Drugs for the treatment of this disease are selected depending on the characteristics of its course. Indeed, in addition to the main clinical manifestations, patients may experience other changes. For example, with cholestasis, jaundice may occur. Despite the fact that this symptom is observed much less frequently than the abovesigns of cholestasis, it deserves special attention. Against the background of a high content of bilirubin in the blood, the epidermis, sclera of the eyes and mucous membranes become yellow.
In addition, sometimes patients have spots on the eyelids - xanthelasma. In children, the manifestations of stagnation of bile also include the formation of xanthoma - focal skin formations, which are small inclusions of cholesterol. Most often, xanthomas appear around the eyes, under the breasts, on the neck of infants. Some symptoms of bile stasis in a child may be caused by a lack of essential polyunsaturated acids, including linoleic, linolenic, arachidonic. In particular, the deficiency of these substances leads to dermatitis, growth retardation, impaired development of the peripheral nervous system.
If a patient, in addition to cholestasis, has a history of other diseases of the digestive system and gastrointestinal tract, there is a possibility of heartburn. Stagnation of bile is characterized by a constant feeling of bitterness in the mouth and dryness, often there is an unpleasant odor due to a deterioration in the digestion and absorption of proteins. Since bile is designed to break down the proteins and nitrogenous bases contained in the incoming products, its excess provokes the appearance of an unpleasant odor. Bitter belching is often added to the symptoms of bile stasis after surgery on the gallbladder.
If fever is observed with cholestasis, most likely, we are talking about the addition of a bacterial infection. Sepsis, phlegmonous organgrenous cholecystitis often develops after endoscopic diagnosis.
What causes bile stasis
The main cause of cholestasis gastroenterologists consider the destruction of hepatocytes as a result of liver cirrhosis (primary biliary or alcoholic). Such stagnation is called hepatocellular. Another group of factors include damage to the liver by infections or parasites, including:
- viral hepatitis;
- hepatic form of tuberculosis;
- opisthorchiasis;
- amebiasis;
- giardiasis.
The cause of symptoms of bile stasis can also be a toxic effect on the liver. Individual components of drugs, including sulfonamides, antibiotics of the penicillin group, analgesics, hormones, can have an aggressive effect on the gland.
The development of cholestasis occurs in the presence of benign or malignant tumors, metastases. Among the reasons why stagnation of bile occurs also include:
- dyskinesia and inflection of the gallbladder;
- gallstone disease;
- inflammatory process in the neck of the gallbladder;
- cystic formations of the bile ducts or their compression by a tumor localized in the pancreas;
- narrowing of the hepatic duct;
- malfunctions in the work of the sphincters of Oddi, Lutkens, Mirizzi, Geister;
- violations of the endocrine and paracrine mechanisms of the gastroduodenal stage of digestion.
Who's in the grouprisk
It is believed that the most common disease occurs in adults. Symptoms and treatment of bile stasis are closely related to physical inactivity: the less the patient moves, the weaker the metabolic processes in his body and, therefore, the higher the risk of developing gallstone disease and biliary duct dyskinesia.
After cholecystectomy, bile stasis is called by many experts a typical postoperative manifestation. Such a consequence of surgical intervention occurs due to scarring of the tissue that narrows the gaps of the biliary canals.
Cholestasis can develop in patients who abuse confectionery, pastries, and fat-containing foods. At risk of bile stasis are people suffering from chronic alcoholism and obesity, who have inherited a genetic predisposition to metabolic disorders.
Treatment of cholestasis with medications
Therapy for this syndrome is based on one of the principles:
- if the cause of cholestasis is known and can be eliminated, etiological treatment is carried out, including surgical treatment;
- Symptoms of bile stasis in adults with no known underlying cause are indications for symptomatic therapy.
If congestion in the liver did not lead to inflammation of the biliary ducts, the patient is prescribed drugs based on ursodeoxycholic acid. This substance is part of bile, has hepatoprotective, choleretic and choleretic properties. Among the pharmaceutical preparations of this group, the following are most often prescribed:
- Ursofalk.
- Cholacid.
- Livodex.
- Ukrliv.
- Ursosan.
- Ursodez.
- Ursochol.
- Choludexan.
These medicines are taken as capsules and oral suspensions. They help reduce the production of cholesterol, prevent its absorption in the small intestine and, as a result, reduce the likelihood of the formation of cholesterol stones. The duration of the course of treatment and the daily dosage, based on the patient's body weight, is calculated by the attending physician. These drugs have many contraindications, in particular, they are not recommended for cirrhosis of the liver, acute cholangitis and cholecystitis, cholelithiasis, as well as liver or kidney failure.
For symptoms of bile stasis in the gallbladder, treatment involves the use of choleretic drugs:
- Holiver.
- Allohol.
- "Hofitol".
- Cynarix.
- Odeston.
- Heptor.
- Artichol.
Most of them contribute to increased bile production, therefore, in acute forms of viral hepatitis, liver dysfunctions and jaundice, such drugs are not used. They are prescribed with caution to children, since choleretic drugs can cause hives, obstruction of the bile ducts.
In addition to medicines, pharmaceutical herbal preparations are used in the treatment of cholestasis. For example, choleretic collection No. 2 includes medicinal plants such as immortelle, yarrow, peppermint,coriander seeds. Children are more often prescribed collection number 3, consisting of calendula flowers, tansy, chamomile and mint leaves. A drinking decoction is prepared from the phytocollection: on average, 1 tbsp is required for 1 cup of boiling water. l. medicinal raw materials. The mixture is put on fire and boiled for about 10 minutes, after which it is insisted for 30 minutes, filtered and drunk before meals in the morning and in the evening, 100 ml each.
Rose hips have similar choleretic properties: you can prepare an infusion from dry fruits of wild roses at home, and for those who do not want to bother, you can buy it at the Holosas pharmacy. Adults need to take the drug on an empty stomach, one dessert spoon once a day, and children - at the same frequency, but half as much.
Surgery for bile stasis
If drug treatment does not bring the expected effect, the patient may be prescribed surgery. Depending on the causes of cholestasis and the localization of bile stasis, patients undergo the following operations:
- removal of stones and calculi from the bile ducts using a laparoscope (endoscopic lithoextraction);
- removal of a cystic or cancerous formation that prevents the outflow of bile;
- stenting of the biliary tract;
- dilatation (expansion with balloons) of the lumen of the bile ducts;
- installation of drainage in the common bile duct;
- correction of the work of the sphincters of the gallbladder;
- cholecystectomy.
Symptoms of bile stasis after removal of the gallbladder in most cases come back again, socholecystectomy is the most radical method of treatment, which is resorted to in advanced cases. An infant with bile stasis due to biliary atresia may require a liver transplant.
Folk treatment
Alternative treatments for cholestasis are quite varied. In addition to taking medications, many doctors recommend parallel treatment with folk remedies. With the symptoms of bile stasis, most of the presented recipes cope without much difficulty:
- Fresh juice. At home, for 1-2 months, you should drink 100-150 ml of juices mixed in equal proportions from apples, beets, carrots. Juices should be taken one hour after eating.
- Apple cider vinegar. One tablespoon of this product is added to a cup of water. They drink liquid without sugar, and if you want to sweeten the drink, you can put one teaspoon of honey.
- Mummy. For 10-14 days, it is necessary to drink mummy tablets dissolved in water. For half a liter of water, 0.2 g of mummy is used. The medicine is drunk before meals in several doses throughout the day. The general course of liver treatment for symptoms of bile stasis is at least three months. In this case, after two weeks of use, it is necessary to take a 5-7-day break. Before using this remedy, you should definitely consult a doctor, since shilajit with such consumption volumes can cause diarrhea and increase blood pressure.
With cholestasis, patients are often advised to eat persimmons - this fruit contains vitamin C, beta-carotene andmanganese, which is a superoxide dismutase cofactor and takes part in the gluconeogenesis of amino acids and cholesterol. In addition, persimmon contains many antioxidant enzymes that increase the resistance of mucous membranes. No less often, with stagnation of bile, it is recommended to use pomegranate. But at the same time, we must not forget that, along with choleretic properties, it has a fastening effect and contributes to the development of constipation.
For patients with cholestasis, homemade herbal decoctions, which have long been used to treat diseases of the hepatobiliary system, will be useful. These include the following plants:
- smoke;
- sandy immortelle;
- three-leaf watch;
- corn silk;
- knotweed;
- grynnik naked;
- alpine arnica.
Basics of nutrition
When bile stasis, diet is a mandatory measure of treatment. Without dietary restrictions, which are clearly described in the "Table No. 5" diet, medicines and folk remedies will not give the expected therapeutic effect. It is necessary to make adjustments to the daily diet immediately after the diagnosis is established. The basic principles of the diet for cholestasis are the need:
- Avoid all fatty foods, especially animal products, including pork, lamb, butter, whole cow's milk, sour cream, rich broths.
- Refuse to eat canned and pickled foods (sausages, smoked meats, pickles,semi-finished products, snacks, etc.).
- Reduce the consumption of flour and confectionery products.
The diet of a patient suffering from bile stasis should consist of fresh vegetables and fruits (heat treatment is allowed for gastrointestinal diseases), lean meat, fish, seafood, legumes. To replenish the fat balance, it is desirable to use walnuts, almonds, flaxseed, pumpkin seeds. For a side dish, a person with cholestasis is better to eat brown rice, buckwheat, oatmeal or barley porridge.
