Home / Treatment / Causes, symptoms and treatments for gallstones

Causes, symptoms and treatments for gallstones

The content of the article:

What is gallstone disease?

Gallstone disease (GSD) is a disease characterized by formation of stones in the gall bladder and its ducts as a result of a breach of certain metabolic processes. Another name for the disease cholelithiasis.

The gallbladder is an organ adjacent to the liver and serves as a liquid reservoir for bile produced by the liver. Gall stones, or calculi, can be both in the gall bladder and its ducts and in the liver and trunk of the hepatic duct. They vary in composition and may have different size and shape. Gallstone disease often provokes the development of cholecystitis (inflammation of gallbladder), as the stones irritate its walls.

Concrements in the gallbladder are formed from cholesterol crystals or calcium pigment and lime salts (in rarer cases). Biliary colic appear when one of the stones clog the duct by which bile flows from the bladder into the small intestine.

The formation of gallstones are a very common illness, which affects about 10% of the adult population in Russia, Western Europe and the United States, and in the age group older than 70 years, this figure reaches 30%.

In the second half of the twentieth century the frequency of surgical interventions conducted at the gallbladder, exceeded the frequency of surgeries for appendicitis.

Gallstone disease mainly occurs among the population of industrialized countries, where people in large numbers consuming foods rich in animal proteins and fats. According to statistics, women cholelithiasis is diagnosed in 3-8 times more often than men.


Symptoms of gallstones

In most cases of cholelithiasis are asymptomatic and have no clinical manifestations for several (usually five to ten) years. The appearance of symptoms depends onthe number of stones, their size and localization.

The main symptoms of cholelithiasis are:

Hepatic (biliary) colic usually develops after eating fatty, heavy meals, spicy and fried foods, alcohol, as well as in conditions of increased physical stress or exertion. The pain starts right under the ribs, may be given in right arm (shoulder and forearm), shoulder blade, lower back, right side of the neck. Sometimes the pain can spread over the sternum, which is similar to an attack of angina.

The pain occurs due to spasm of the muscles of the gall bladder and its ducts, occur in response to irritation of the wall of the bladder stones or due to excessive stretching of the bladder walls as a result of excess accumulated gall.

Strong pain syndrome is also noted in the movement of stones in the biliary tract and blockage of the stones of the lumen of the bile duct. Complete obstruction leads to enlargement of the liver and stretching of its capsule, which causes permanent dull pain and feeling of heaviness in the right hypochondrium. In this case develops obstructive jaundice (the skin and the sclera of the eyes turn yellow), which is accompanied by discoloration of feces. Other symptoms of complete obstruction of the duct can be high temperature, excessive sweating, fever, convulsions.

Sometimes biliary colic go away on their own after the stone passes through the bile duct into the small intestine. Usually an attack lasts no more than 6 hours. To relieve pain you can apply a heating pad on the right hypochondrium. If the stone is too large, can't get out of the bile duct, a further outflow of bile becomes impossible and the pain, requires immediate surgery.

Common symptom of cholelithiasis is vomiting bile, which does not bring feelings of relief, because it is a reflex response to the irritation of some areas of the duodenum.

Temperature rise to subfebrile values (not above 37°- 37,5°C) indicates the accession of infection and development of gallbladder inflammation. The development of cholecystitis is accompanied by decreased appetite and increased fatigue.


The causes of formation of gallstones

Healthy bile is liquid and forms stones. The factors causing their formation, are:

  • Elevated levels of cholesterol in the composition of bile, which change its properties;

  • The violation of the outflow and stagnation of bile;
  • Getting into the gallbladder infection and the subsequent development of cholecystitis.

The main reason for the formation of concretions is a violation of the composition of bile – the balance between cholesterol and bile acids. Bile with the excess cholesterol and bile acid deficiency is called lithogenic.

The high content of cholesterol in bile is due to the following reasons:

  • Excessive consumption of foods high in cholesterol (animal fats);
  • With impaired hepatic function, when decreased production of bile acids;
  • The presence of obesity, which is observed in approximately 2/3 of patients;
  • Prolonged intake of oral contraceptives containing estrogen (in women);
  • The presence of other diseases such as diabetes mellitus, hemolytic anemia, liver cirrhosis, Allergy, Crohn's disease and other autoimmune conditions.

By reducing the contractile function of the gallbladder is the deposition of cholesterol flakes, of which later formed clots, cholesterol stones.

Causes of obstructed outflow of bile and stagnation to become the following factors:

  • The presence of certain diseases: dyskinesia (impaired contractile function) of the biliary tract, flatulence (excessive pressure in the stomach obstructs the flow of bile), as well as surgery on the gastrointestinal tract in the anamnesis (vagotomy etc.);
  • Sedentary lifestyle;
  • Pregnancy (pressure of the uterus on the organs of the peritoneum also prevents the flow of bile);
  • Wrong diet with significant gaps between meals and fasting and the sharpweight loss.

In addition to the functional Genesis (dyskinesia) bile stasis can be caused by mechanical reasons, i.e. the existence of barriers to movement: these include adhesions, tumors, swelling of the bladder walls, bend or narrowing of the bile duct, and congenital anomalies: cysts of the main bile duct diverticula (bulging wall) of the duodenum.

And finally, the third reason is an infection of the gallbladder, which occurs by ascending from the intestine or through the blood and lymph circulation and can result in cholecystitis (inflammation of the mucous wall of the bladder) and cholangitis (inflammation of bile ducts). Chronic cholecystitis and cholelithiasis is interdependent condition when one of the diseases supports, accelerates and makes it more difficult for another.

There are two types of stone formation:

  1. Primary stones begin to form in the biliary tract unchanged and for a long time do not cause any clinical symptoms.

  2. Secondary stone formation occurs on the background of violations of the outflow of bile: cholestasis (reduction of bile entering the duodenum), bile hypertension (increase in pressure in the common bile duct, which leads to its expansion); in the blockage of primary stones of the biliary tract. The formation of cicatricial stenosis of the lumen and in the biliary tract leads to the introduction into the gall bladder ascending infection of the lower GI tract.

Thus, the appearance of the primary concretions of the crucial role played by violations of structural composition of bile. Formation of secondary rocks is the result of cholestasis and infection of the gallbladder. Primary stones are formed primarily in the gallbladder because of stagnation and thick bile. Secondary stones may form in the bladder and in the ducts, and intrahepatic bile.


What size reach the gallstones?

The gallbladder is a hollow organ located under the liver and serves to store bile. Bile is produced continuously by the liver, concentrated in the gallbladder and periodically enters the duodenum via the bile duct. The bile is directly involved in the digestive process and consists of bile acids, pigments, cholesterol and phospholipids. With prolonged stagnation of bile, cholesterol precipitates that gradually leads to the formation of so-called "sand" particles whichtime increase in size and are interconnected in more stones.

According to the structure of the gall stones are divided into homogeneous and complex (consisting of core, body and bark). The core usually consists of bilirubin. Homogeneous rocks are usually composed of clots of mucus, pure cholesterol, and foreign objects (fruit pits, etc.).

The chemical composition distinguished cholesterol, calcareous, pigmented and mixed stones. Stones composed of one component, are relatively rare. Most of the stones have a mixed composition with a predominance of the share of cholesterol. Stones with a predominance of pigments typically contain a significant proportion of the admixture of lime salts, so they are called pigment-lime. The structure of the rocks can be crystalline or layered, texture – hard or waxy. In most cases, gall bladder of one patient contains stones with different composition and structure.

Sizes of stones vary in very wide limits, from a few millimeters to several centimeters and can reach a value of hazelnut or eggs. Sometimes one stone occupies the whole cavity of the gall bladder is stretched and has a weight of 70-80 grams. Form of gallstones can also be any.

Stones with a diameter of 1-2 mm can pass through the bile ducts, the presence of larger stones complications and the symptoms described above. In medicine recorded that when one gallbladder contained about 7000 stones.

Possible complications

  • Acute cholecystitis;
  • Obstruction of the biliary tract with subsequent accession of infection and development of chronic cholecystitis and pancreatitis;

  • Perforation (rupture) of the gallbladder and its consequences in the form of peritonitis;
  • Getting large concretions in the intestines and intestinal obstruction;
  • The risk of the cancer process in the gall bladder.


Diagnosis of cholelithiasis

The presence of gallstones is set on the basis of the ultrasound examination. The larger sizes can be determined by touch. With the help of ultrasound is determined by the number, size and localization of stones, and is diagnosed as gallbladder (e.g., thickening of its walls, evidence of inflammation).

If the diagnosis is difficult, apply more complex methods, which include oral cholecystography (x-ray examination after oral administration of drugs, contrasting bile), retrogradecholangiopancreatography (an x-ray examination with endoscopy and injection of contrast into bile ducts).

Treatment of gallstones

Modern conservative treatment, allowing you to save your organ and its ducts, comprises three basic methods: dissolving stones with drugs, crushing of stones with ultrasound or laser and percutaneous halitosis (invasive).

Medical dissolution of stones (oral litholytic therapy)

Dissolution of stones is drugs Ursosan (ursodeoxycholic acid) and Chenofalk (chenodeoxycholic acid). These drugs lower the level of cholesterol in the composition of bile and increase the content of bile acids.

Litholytic therapy is indicated in the following cases:

  • The stones are cholesterol nature. The chemical composition of rocks can be determined using duodenal (duodenum) or oral holetsistografii;
  • The stones are small (5 to 15 mm) and filled no more than 1/2 of the gallbladder;

  • Contractile function of the gallbladder in the normal patency of the bile duct good;
  • The patient can take acid regularly in the long time.

In parallel we should refuse to accept other medications, provoking stone formation: estrogen included in the composition of the contraceptives; antacids are used ulcer to reduce acidity and will prevent the absorption of acids; holestiramina designed for capture and output of cholesterol.

Contraindications for this method is the most diseases of the gastrointestinal tract and kidneys. The dose and length of treatment prescribed by the doctor individually. The course of treatment lasts from 6 to 24 months (at least) and is performed under ultrasound control. The effectiveness of therapy depends on the dose of the drug and size of the stones and is 40-80%. In parallel, you need to conduct a correct way of life and observe preventive measures to prevent the formation of new stones.

For this method characterized by high frequency of relapse after completion of treatment (70%), because after stopping the medications cholesterol in bile increases again. Therefore, as prevention will have to continue to take the low (maintenance) dose datadrugs.

Theme: Drugs to dissolve gallstones

Extracorporeal ultrasonic lithotripsy

This method is based on crushing of stones under high pressure, which is created by the shock wave. Ultrasound breaks the stones into smaller particles size up to 3 mm, which later transferred to the bile ducts into the duodenum.

In practice, extracorporeal lithotripsy is often combined with the previous method, i.e. small stones dissolve with the help of drugs (Ursosan or Henofalk). In a similar way operates the laser method, when the concretions in the gall bladder are crushed by means of a laser.

This treatment is suitable for patients who have detected a small number (up to 4 pieces) of fairly large cholesterol stones (up to 3 cm) without calcium admixtures in their composition or one large stone. Usually held from 1 to 7 sessions.

Contraindications are:

  • Of blood clotting;
  • Chronic inflammatory diseases of the gastrointestinal tract (cholecystitis, pancreatitis, ulcers).

To side effects ultrasonic lithotripsy include:

  • The risk of blockage of the bile ducts;
  • Damage to the walls of the gallbladder stone fragments as a result of vibration.

Either of these effects may precipitate an inflammatory reaction and, as a consequence, the formation of adhesions. When blockage of the ducts may require emergency surgery, and the results of term operations is usually worse than planned, when a person undergoes a preliminary examination and training.

Percutaneous transhepatic halitosis

This is an invasive method that is seldom used. With its help not only dissolve cholesterol stones, but any other. This method can be used at any stage of the disease and, unlike the previous two, not only when asymptomatic disease, but in the presence of its clinical symptoms.

Halitosis is as follows: through the skin and liver tissue in the gallbladder thin catheter, which is introduced dropwise 5 to 10 ml of a special drug (methyl tertiary-butyl ether), dissolving the stones. The procedure is repeated several times over 3-4 weeks, during this time, dissolved to 90% of stones.

Operative treatment is indicated inlarge stones and frequent exacerbations that are accompanied by severe pain seizures, high fever and diverse complications. Surgery can be laparoscopic or open.

Laparoscopy stones gallbladder

Extraction of stones laparoscopic method is practiced infrequently and only in some clinics. In this operation right under the ribs incision is made 1.5-2 cm for the penetration into the peritoneum. With the help of the laparoscope is determined by the location and size of the gall bladder, the status of the other abdominal organs.

Monitored the gallbladder is tightened to the first incision, and at its base is cut 0.5-1 cm, through which the contents of the bubble is studied. Then through this incision introduced a special soft tube which is inserted into choledochoscope – this ensures that no damage to the walls of the bubble choledochoscope.

Stones extracted from the bladder, with large stones caught in the flow, are crushed into smaller ones. After removing all the stones choledochoscope is removed, the incision on the bladder is sutured with absorbable thread. An incision in the skin is sealed with a medical adhesive.


Removal of the gallbladder (cholecystectomy)

Currently, the most common treatment of cholelithiasis, accompanied by cholecystitis is removal of the gallbladder along with the stones. Explain that the reason for calculous cholecystitis is in the metabolic disorders that directly affect the composition of bile, so mechanical removal of the stones will not solve the problem, they will appear again.

In laparoscopic cholecystectomy the bladder is removed through small incisions up to 1.5 cm on the anterior surface of the abdomen using a laparoscope (tube with a video camera).

Its advantages over open cholecystectomy:

  • Quick recovery after surgery;
  • The lack of visible scars;
  • Reducing the risk of postoperative hernias;
  • A lower cost.

Contraindications:

Consequences of gallbladder removal

Surgery not only removes the symptoms of gallstones. Removal of the bladder is due to the formation of stones in it, which may be caused by a pathological change in the chemical composition of bile, and after surgery, this reason remains valid. After cholecystectomy patients complain of pain in the right hypochondrium and in the liver are stored, there is often a bitterness in the mouth, the food has a metallic taste. Cumulative effects removal of gallbladder is called post cholecystectomy syndrome, which involves a group of symptoms directly or indirectly related to the operation, as well as diseases, which are beginning to progress after it.

Cholecystectomy, according to some, leads to an increase in the common bile duct. If you have a gallbladder this volume is 1.5 ml, 10 days after removal – 3 ml, and a year can reach 15 ml. This is due to the need for reserves of bile in the absence gallbladder. Another consequence may be a narrowing of the common bile duct because of his trauma during the operation. This will result in retidiviruuschem the cholangitis, bile stasis and jaundice.

The main problems arise with the liver, pancreas and duodenum. As a reservoir for collecting the bile is missing, it starts an uncontrolled flow to the intestine, thus lithogenicity (violation of the chemical composition) of bile is stored. Duodenum becomes available for bacteria, which leads to disruption of the metabolism of bile acids, with the result that they strongly irritate the mucous membrane of the intestine. It promotes development of duodenitis, esophagitis, enteritis, colitis.


Diet in cholelithiasis

The composition of the diet is of great importance in this disease. It is recommended to stick to a fractional power, eat 5-6 times a day. The eating has choleretic effect, so the arrival in the stomach small quantities of food at the same time stimulates the flow of bile and prevents its stagnation. But large portions of food the gallbladder may instinctively shrink, and it will cause aggravation.

The diet should contain sufficient amounts of animal protein, animal fats are also not prohibited, but is normally transferredbad, therefore, to give preference to vegetable fats. Cholelithiasis is useful to consume foods rich in magnesium.

Recommended products:

It is recommended to exclude from the menu the following products and dishes:

  • Fatty meats (pork, lamb, beef) and fish, and fat, liver and offal;
  • Sausages, smoked meats, preserves, pickles;
  • Butter (limit, it is desirable to add to the mess);
  • Legumes, radish, radish, eggplant, cucumbers, artichokes, asparagus, onions, garlic;

  • Fried, sour and spicy dishes;
  • Rich broth;
  • Coffee, cocoa and alcohol.

On topic: the Diet for gallstones menu for a week


Prevention of gallstone disease

To prevent the formation of gallstones, you should:

  • Avoid eating large meals with high fat and cholesterol;
  • In the presence of overweight or obesity low fat diet and exercise, the weight decreased gradually;
  • To normalize metabolism, to reduce the production of cholesterol by the liver and stimulate the secretion of bile acids. For this purpose appointed by such drugs as sikorin, liobil.

orshenin Elena Ivanovna, doctor-gastroenterologist