Gallstone disease

Risk factors

Symptoms of gallstone disease

Required examinations

Treatment of gallstone disease

Gallstone disease is a disease characterized by the formation of gallstones or bile ducts. Also known as cholelithiasis , gallstones.

Stone formation is a stage process with periods of active growth and remission.

Risk factors

There are several reasons for the occurrence of gallstone disease:

  • excess cholesterol secretion to bile
  • reduced secretion of phospholipids and bile acids to bile
  • bile stasis
  • biliary tract infection
  • hemolytic diseases.

Most gallstones are mixed. They contain cholesterol, bilirubin, bile acids, proteins, glycoproteins, various salts, trace elements. Cholesterol stones contain mainly cholesterol, have a round or oval shape, layered structure, diameter from 4–5 to 12–15 mm, are localized in the gall bladder.

Cholesterol- pigmented limes – multiple, have faces, the shape is different. Significantly vary in number – tens, hundreds and even thousands.

Pigment stones are small, multiple, rigid, fragile, perfectly homogeneous, black with a metallic tinge, located both in the gallbladder and in the bile ducts.

Calcium stones consist of various salts of calcium, a freakish form, have spiky processes, of light or dark brown color.

Symptoms of gallstone disease

Conventionally, there are several forms of the disease.

Latent form of gallstone disease. 
It should be considered rather as one of the phases in the course of gallstone disease. It can last for a very long time in the absence of manifestations.

Dyspeptic chronic form of the disease. 
Its manifestations:

  • uvstvo heaviness in the epigastric and right hypochondrium,
  • heartburn,
  • flatulence ,
  • unstable chair.

The appearance of pain provokes the use of fatty, fried, spicy foods, too large portions of food.

Painful chronic form of gallstone disease. 
This form of pronounced pain attacks are absent. The pains are aching in nature, localized in the epigastric and right subcostal areas, spread to the area of ​​the right scapula. There are weakness, malaise, irritability.

Biliary colic and chronic recurrent form. 
This is a sudden attack of intense pain in the right hypochondrium and the epigastric region. It is provoked by eating fats, spices, negative emotions, physical tension, pregnancy, menstruation.

Required examinations

  • Blood chemistry
  • Ultrasound
  • Pre dudenal sounding
  • X-ray

Treatment of gallstone disease

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Treatment of gallstone disease depends on the form of the disease and the degree of operational risk.

1. With single stones of the gallbladder with a diameter of more than 1-2 cm, multiple stones are removed gallbladder. The gold standard of surgical treatment is cholecystectomy – removal of the gallbladder. Radical surgery for cholelithiasis provides complete recovery in 95% of patients. In 10% of patients delaying the operation leads to a worsening of the course of the disease.

2. Dissolving or crushing of stones is shown in cases with small stones (up to 1 cm) and single stones.

Crushing is carried out using ultrasound or electromagnetic waves. Crushing of gallstones occurs as a result of the impact of a shock wave on a stone, which is formed by a spark discharge or excitation of piezocrystals and is focused on a stone with the help of a parabolic reflector. At the focal point, the wave energy reaches its maximum. In this case, a deformation occurs in the stone, which exceeds the strength of the stone. Not one, but a lot of shock waves enter the stone – from 1,500 to 3,500, depending on the composition of the stone. Such multiple shock waves destroy it into small fragments.

Small fragments, the size of which does not exceed the diameter of the cystic duct, leave the gall bladder through the cystic duct. Further, through the common bile duct, they enter the intestine and are removed from the body.

Larger fragments that cannot pass through the cystic duct remain in the gallbladder. Therefore, to increase the effectiveness of treatment, it is advisable to add bile acid preparations to extracorporeal lithotripsy.

The main disadvantage of this method is the high probability of recurrence, that is, the reappearance of gallstones. After 5 years, the recurrence rate is 50%.

3. Dissolution of gallstones is possible only with cholesterol stones.

To do this, apply ursodeoxycholic acid at 15 mg / kg per day in 2-3 doses, take about 2 years. Chenodeoxycholic acid, 15 mg / kg per day (1/3 doses in the morning and 2/3 in the evening), are taken for a year or more.

Contact dissolution of stones is carried out using methylbutyl ether: through the introduction of the drug into the lumen of the gallbladder.

4. Diet : food containing large amounts of plant fiber, vitamin C, reduced amounts of protein and fat. Food should be taken in small portions 5-6 times a day. 

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