Postcholecystectomy syndrome (PCES) - what is it? Some believe that this is some kind of specific disease. No, it's not. This is a whole complex of clinical manifestations that can be observed either after removal (resection) of the gallbladder (GB), or as a result of any other surgical measures performed on the bile ducts. Moreover, the syndrome can form immediately after surgery, or it can manifest itself after a couple of months or years.
Note! Women develop PCES more often than men.
Sometimes, patients have manifestations of the pathology that were observed before the operation, but new ones may appear. Moreover, the symptoms of postcholecystectomy syndrome and the treatment of the disease directly depend on the root cause of the pathology and the changes that have occurred in the biliary system.
Note! Not always resection of the gallbladder is the cause of suffering for patients. Sometimes these symptoms can be associated with pathologies of the stomach,liver, duodenum or pancreas.
Classification of postcholecystectomy syndrome
PCES are divided into three groups:
- Not in any way related to GB resection. It's just that these symptoms can be caused by pathologies of a concomitant nature.
- Directly related to surgery such as removal of the gallbladder. These may be suture granulomas, postoperative pancreatitis or bile duct injury.
Motor disturbances (e.g. sphincter of Oddi spasm or dyskinesia)
Possible causes of PCES
Causes of postcholecystectomy syndrome:
- Disturbances in the biliary system (in the distribution of bile).
- The appearance of some neoplasm of a muscular nature in the area of the junction of the bile duct and duodenum 12 (spasm of the sphincter of Oddi).
- Dysbacteriosis.
- Violations of tone and motility of the biliary tract (BIT), their dyskinesia.
- Accumulation of fluid in the cavity formed after surgery.
- Presence of stones in the bile ducts.
- Infection of the duodenum 12.
- Cyst of the common bile duct, which is its extension. This anomaly merges with the pancreatic duct.
- Liver pathologies (such as hepatitis or cirrhosis).
- Problems related to the digestive organs.
- Incorrect preoperative patient preparation.
- Mistakes made by surgeons duringsurgery (for example, trauma to the vessels of the gallbladder or its ducts).
- Misdiagnosis.
- Failure in the functioning of the gallbladder (for example, a violation in the process of outflow of bile into the intestine or a decrease in its amount).
- "Occupation" of the gastrointestinal tract by pathogenic microflora.
- Violation of bile circulation, when it cannot get through certain ducts into the duodenum, this may be due to their blockage or partial narrowing.
- Pathologies that occurred either before surgery on the biliary tract, or developed after (for example, pancreatic pancreatitis, duodenal ulcer, duodenogastric reflux, characterized by the reflux of intestinal contents back into the stomach, irritable bowel syndrome).
Symptomatics
If any of the following symptoms appear, immediately seek help from a medical facility where you will be fully diagnosed and prescribed the necessary treatment:
- Recurrent attacks of pain (in the right hypochondrium or epigastric region, radiating either to the right shoulder blade or to the back) that last about 20 minutes or more. Moreover, the intensity of pain increases at night or after the next meal.
- Disturbances in the digestive tract.
- Diarrhea, manifested in the form of liquid and watery stools, which can be repeated about 10 times a day.
- The presence of fatty inclusions in the composition of feces.
- Weakness,drowsiness and fatigue associated with malfunctions of the central nervous system.
- Insufficient intake of vitamins in the body (compared to their consumption), developing hypovitaminosis.
- Burping with a bitter taste.
- The accumulation of digestive gases in the intestines in excess (flatulence).
- "Rumbling and seething" in the stomach.
- Heartburn.
- Micronutrient deficiency.
- Itching of the skin.
- Fast weight loss (stage 1 - loss of about 5-8 kg; stage 2 up to 8-10 kg; stage 3 - more than 10 kg).
- Intolerance to fatty foods.
- The presence of cracks in the corners of the lips. It occurs due to a violation of the absorption of nutrients in the small intestine (malabsorption).
- Jaundice.
- Nausea, sometimes turning into vomiting.
- Hyperhidrosis (excessive sweating).
- Hyperthermia up to 38-39 degrees.
Classification of pain sensations
Briefly about postcholecystectomy syndrome, and to be more precise, about the types of pain that can be:
- Pancreatic in nature. Pain is provoked by a malfunction of the Westphal sphincter, which provides separation of the duodenum and ducts suitable for other digestive organs. There is pain in the hypochondrium on the left, passing into the back and decreasing when the body is tilted forward.
- Biliary character. Pain is provoked by disturbances in the functioning of the papilla of Vater, through which pancreatic juice and bile enter the duodenum. Pain is localized inhypochondrium on the right and in the upper abdomen, it can give into the scapula on the right and in the back.
- Ciliary-pancreatic character. As a result of dysfunction of the sphincter of Oddi (in the normal state, it promotes the flow of bile and pancreatic juice into the duodenum 12, and also prevents the reverse ejection of intestinal contents through the ducts), pain sensations encircling the whole body appear.
Diagnosis
Treatment of postcholecystectomy syndrome largely depends on the correct diagnosis. When a patient contacts a medical institution, the doctor carefully listens to all complaints, collects an anamnesis (that is, information about previous diseases, hereditary predispositions, as well as diet and regimen) and visual examination of the patient. Further, in order to accurately determine the cause of the disease, the specialist prescribes the following to the patient:
- General clinical blood test. They do this in order to exclude the possible presence of inflammatory processes.
- Plasma biochemical analysis to help determine the amount of lipase, bilirubin, enzymes (amylase) and alkaline phosphatase.
- Ultrasound of the abdomen.
- X-ray examination of the stomach with barium.
- SCT (spiral computed tomography), which gives an accurate picture of the state of the vessels and organs in the abdominal cavity.
- Gastroscopy to exclude any pathology of the gastrointestinal tract.
- ERCPG (endoscopic retrograde cholangiopancreatography). A study that allows you to observe the ducts of the pancreas and biliary tract usingx-ray unit.
- ECG to rule out abnormalities in the work of the heart muscle.
- Scintigraphy. The method allows you to determine the presence (or absence) of disorders in the circulation of bile. Radioactive isotopes that emit certain radiations are injected into the patient's body. As a result, it becomes possible to obtain a two-dimensional image.
Note! If there is not enough information to make a diagnosis, then the patient can undergo diagnostic surgery. They rarely do this.
Therapy
Treatment of PCES (postcholecystectomy syndrome) with medical drugs:
- Anspasmodics to relieve pain (for example, "No-shpa" or "Spasmalgon").
- Choleretic drugs that promote the formation of bile and its outflow ("Holenzim", "Allohol" or "Nicodin").
- Cholinolytics blocking cholinergic receptors.
- Preparations containing enzymes that improve the digestion process (for example, Ermital, Gastenorm forte or Normoenzyme).
- Antibacterial agents such as Doxycycline, Furazolidone or Metronidazole.
- Probiotics that help restore natural microflora (for example, Bifiform, Linex or Acipol).
- Prokinetics, well stimulating the motor function of the digestive tube and preventing the formation of waves that interfere with normal peristalsis ("Motilium", "Trimedat" or "Neobutin").
- Hepatoprotectors that have a positive effect on workliver.
- Sorbents. They do not allow toxins to be absorbed into the blood. Sorbents such as activated carbon, Sorbex (in capsules) or Carbolong help to remove toxic substances from the human body.
- Intestinal antiseptics that eliminate a symptom such as fermentation (for example, Intetrix, Stopdiar or Enterofuril).
- Do not forget about multivitamin or vitamin complexes.
- Nitroglycerin. Relaxes the smooth muscles of the bile ducts (for example, normalizes the work of the sphincter of Oddi) and the entire gastrointestinal tract.
- Drugs belonging to the group of antacids. Neutralize the hydrochloric acid present in the gastric juice and thus contribute to the normalization of acidity in the stomach.
In addition to drug therapy, the doctor gives recommendations regarding possible physical activity (prescribes exercise therapy), diet and diet, and the possibility of using certain traditional medicine recipes. Modern treatment of PCES may involve surgical intervention. This is possible, of course, if there is weighty evidence.
Note! In Moscow, the treatment of postcholecystectomy syndrome can be carried out in such clinics as "Capital" (on Leninsky Prospekt), "Atlas" (on Kutuzovsky Prospekt) or "European" (on Shchepkina Street).
Traditional medicine
Phytotherapy can significantly alleviate the condition of a patient suffering from PCES after the removal of such an important organ as the gallbladder. Remember: all activities related to the use of traditional medicine recipes must take placein parallel with the main drug therapy. Here are some easy ways to treat postcholecystectomy syndrome with herbs:
- Collection 1. It is used to restore the functioning of the biliary tract. Mix cudweed grass, hop cones, marigold flowers and valerian root in a ratio of 2:1:2:1. How to brew is described below, for three fees at once. Use 2-3 times a day for 1/3 cup. The course of therapy is about 1 month.
- Collection 2. Recommended to eliminate the inflammatory process in the bile ducts and stagnation of bile. Calamus root, corn stigmas, celandine grass, bird knotweed and centaury are mixed in a ratio of 3:2:1:2:2. Take tincture 2 times a year (the duration of one course is 30 days).
- Collection 3. Suitable if you are concerned about the poor functioning of the biliary tract and the sphincter of Oddi. Elecampane root, chamomile flowers and St. John's wort are mixed in a ratio of 1, 5: 1: 1.
Important! All the above fees are brewed as follows: the herbal mixture (1 tablespoon) is poured with boiling water (200 ml), insisted for 15-20 minutes, filtered and drunk before meals (20 minutes) or after (after 60 minutes). The course of therapy for each collection is no more than 1 month.
- In combination with drug treatment of postcholecystectomy syndrome, you can drink herbal infusions that help relieve inflammation and spasms, and also have sedative and immunomodulatory effects. For example, a decoction made from calendula flowers, birch leaves, knotweed and rose hips is an excellent remedy.
- Another recipe to deal with PCES. Rose hips, the root of the bird's mountaineer and cyanosis, nettle and golden volodushka are mixed in a ratio of 2: 1: 1: 2: 1. Pour the green mass (2 tablespoons) with hot water (500 ml), insist under the lid for 4-5 hours, strain and consume 150 ml 3 times a day.
- At the first symptoms, immediately begin treatment of postcholecystectomy syndrome, for example, with a decoction of herbs such as cinquefoil, lemon balm, celandine and peppermint. Mix them in equal proportions, then pour the prepared green mixture (1 tablespoon) with boiling water (200 ml), insist under the lid for 2-3 hours, strain and drink ½ cup twice a day.
- To normalize the functioning of the gastrointestinal tract, it is recommended: in case of diarrhea - mix quince syrup (50 ml) with horsetail juice (50 ml) and drink this portion in three doses during the day; in case of constipation, drink three times a day, one teaspoon of vegetable oil (preferably sesame).
- Crushed fresh ivy (50 g) is poured with dry red wine (0.5 l), the mixture is infused for a week, it should be consumed after each meal (1-2 sips).
Treatment of postcholecystectomy syndrome with Ursosan
The tool does an excellent job with PCES. The main active ingredient of the drug is ursodeoxycholic acid. In the pharmacy network, the drug is presented in the form of hard capsules, inside which there is a white powder.
For the preventive purposes of recurrent cholelithiasis after PCES, patients are prescribed one capsule (250 mg) 2 times a day.day (treatment in this way is necessary for 1-2 months). It is necessary to take the drug either after a meal, or in its process. Moreover, the capsules do not need to be chewed. It is recommended to drink plenty of water.
There are certain contraindications in the treatment of postcholecystectomy syndrome with a drug such as Ursosan:
- increased individual sensitivity to the main and additional components;
- acute inflammatory processes in the intestines and bile ducts;
- cirrhosis of the liver;
- gallstones;
- certain malfunctions in the functioning of the pancreas, liver and kidneys;
- chronic hepatitis;
- absence of JP;
- pregnancy;
- pancreatitis;
- breastfeeding.
Important! "Ursosan" can be taken only as directed by a doctor. Self-medication is dangerous to your he alth.
Nutrition for PCES
Recommendations regarding regimen and diet for postcholecystectomy syndrome (symptoms and treatment of exacerbations have been described above):
- Drink about 2 liters of water a day.
- The calorie content of consumed foods should not exceed 300 kcal.
- Spicy, spicy, acidic and choleretic foods, as well as fatty and fried foods should be avoided.
- The amount of fat per day should be about 50-60 g; proteins - 100 g, and carbohydrates - 400 g.
- Remember to include B and A vitamins in your diet.
- Eat during the day you need about 5-7times (in small portions).
Foods you can eat:
- rye bread and wheat bread;
- soups: beetroot, borscht;
- bad pastries, cookies, dry biscuit;
- beef, lamb, chicken, turkey and lean fish;
- acidophilus, kefir, quenelles, low-fat cottage cheese, milk and cheese;
- any cereals;
- vegetables (baked or stewed);
- juices, rosehip broth, tea, jelly, coffee with milk, unsweetened compotes;
- vitamin and vegetable salads, vinaigrette;
- zucchini caviar, gravy;
- dill, parsley;
- vanillin, cinnamon;
- any fruits and berries (non-acidic only), dried fruits;
- marmalade, jelly, candies without chocolate, marshmallow, honey, jam (if sorbitol or xylitol is used instead of sugar).
Foods to Avoid:
- okroshka, green cabbage soup, broths;
- fresh pastries, puff pastry;
- pork, goose, duck, offal;
- sausage, sausages, canned food, sausages;
- fatty fish, smoked meats;
- sour cream, cream, fermented baked milk;
- milk, cheese and high-fat cottage cheese;
- mushrooms, radish, legumes, spinach, garlic;
- black coffee, cold drinks, cocoa;
- sorrel;
- spicy and greasy snacks;
- chocolate;
- horseradish, mustard;
- pickled vegetables;
- ice cream, cakes and pastries.
Bdetention
Now you know a lot about postcholecystectomy syndrome (causes, diagnosis and treatment). We hope this information will help you cope with this disease and continue to enjoy life. He alth to you and your loved ones!
