Gallstone disease or cholelithiasis is a pathology that is characterized by the formation of stones in the gallbladder and ducts. This is due to problems in cholesterol metabolism and bilirubin production.
Stones can be in large numbers, and they look like dense calculi. 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 ducts). In the ducts of the liver, stones can become branched. Depending on the composition, stones are divided into pigmented, 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.
Mostly gallstone disease is characteristic of the elderly over 70 years old (approximately 45%). Moreover, in women this pathology is detected five times more often than in men. In children, this disease is very rarely diagnosed.
How does the disease occur?
Stones form in the gallbladder in two ways: inflammatory and metabolic. Due to nutritional problems and certain pathological processes, the level of cholesterol and bile acids changes in the body. The composition of bile becomes atypical in nature, 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 precipitates, which leads to the formation of calculi in the gallbladder.
The inflammatory process of the gallbladder, which is infectious or reactive in nature, can also cause a violation of the chemical composition of bile, making it more acidic. As a result, protein fractions become smaller, 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 the disease
Among the main factors that provoke the development of gallstone disease, it is worth highlighting the following:
- too much cholesterol is released into the blood;
- changes in the composition of bile, the formation of lithogenic bile, which has in its composition an excessive amount of fat;
- the release of a reduced amount of phospholipids;
- violation of the flow of bile, that is, cholestasis;
- the development of infectious diseases in the biliary tract.
Diseases that can trigger the development of cholelithiasis are:
- diabetes;
- anemia and other blood diseases;
- gout;
- metabolic problems (protein, lipid, salt);
- cirrhosis, hepatitis;
- disorders of a neuroendocrine nature, including dysfunction of the parathyroid and thyroid glands;
- toxic liver disease;
- gallbladder inflammation;
- congenital abnormalities and diseases of the abdominal cavity organs, for example, stenosis, bile duct cyst, etc.
- parasitic diseases;
- oncological tumors of internal organs.
Factors that can provoke pathology
These factors include:
- a menu consisting mainly of fatty foods of animal origin;
- predisposition to diseases of the gallbladder and liver;
- lack of fiber in the diet;
- sedentary and sedentary lifestyle;
- obesity;
- advanced age, female gender;
- repeated birth;
- fast weight loss;
- pregnancy;
- continuous parenteral nutrition;
- hormonal contraceptives.
Clinical picture
It is important to know that a couple of years can pass from the moment the formation of calculi begins to the first symptoms of cholelithiasis.
The main symptoms of gallstone disease:
- jaundice;
- pain in the back, in particular in the region of the right scapula;
- 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;
- a feeling of heaviness in the epigastrium;
- urine acquires a dark shade;
- in some cases, itching of the skin begins.
Stages of the disease
During the period of active development, cholelithiasis passes through such stages:
- Latent, in which the disease is just beginning and does not manifest itself with any symptoms.
- Chronic dyspeptic, which is characterized by minor pain, a feeling of heaviness in the gallbladder and stomach, sometimes there are attacks of nausea and heartburn. Already at this stage, treatment for cholelithiasis is required.
- Painful recurrent pain - characterized by periodic bouts of colic.
- Angina pectoris, which manifests itself in the form of heart pain. It can occur even after the first stage and flow into the third.
- Saint Triad is a rare type of pathology, which, in addition to gallstone disease, is also accompanied by diaphragmatic hernia and diverticula of the colon.
Complications and consequences
The formation of stones in the gallbladder leads not only to disruption of the functioning of this organ, but also to damage to others. Therefore, it is important to seek the help of a doctor in a timely manner to identify symptoms and treat cholelithiasis.
An acute inflammatory process 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 liver failure pose a serious danger.
A very common complication of gallstone disease is bowel obstruction and bleeding from the colon. As soon as cholelithiasis is complicated by infectious inflammatory processes, jaundice, cholangitis, fatty hepatosis, cholecystitis, pancreatitis can appear. Of the serious consequences of gallstone disease, it is worth noting dropsy and empyema of the gallbladder, cirrhosis, abscess and cancer of the gallbladder.
In determining cholelithiasis, the medical history plays an important role. To make an accurate diagnosis, contact your physician, gastroenterologist and hepatologist immediately. 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 white blood cells;
- research of bile of microscopic and biochemical types.
2. Diagnostic methods using tools:
- duodenal sounding;
- X-ray of the abdominal cavity, as well as cholecystography intravenously, orally or infusion;
- in the acute form of the disease, when surgery is needed, 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, resort to such therapy:
- regular and prolonged observation in the hospital, ultrasound examination of the gallbladder;
- adherence to a special diet.
If the disease is already accompanied by regular bouts of colic, the patient is placed in a hospital where the following methods of treatment 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 there are no positive results, resort to a perirenal 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 are prescribed, as well as microcurrent therapy.
- With cholelithiasis, preparations of a choleretic property are prohibited, because this leads to a serious and dangerous movement of calculi.
Treatment of large formations
If the stones do not exceed two centimeters and have a cholesterol nature, use methods of their dissolution. These include the use of special cholelitolytic drugs:
- chenodeoxycholic acid (the course of treatment is a whole year, the dose is periodically increased);
- ursodeoxycholic acid (application is extended 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 the stones, they resort to the introduction of methyl tertiary butyric ether directly into the lumen between the bile ducts or into the lumen of the gallbladder.
As a hardware method for calculus removal, extracorporeal shock wave lithotripsy is used. The same method is used to eliminate small stones of a cholesterol nature in order to maintain the functions of the gallbladder. However, this method has a large number of contraindications.
If the stone is one, but large, a laparoscopic cholecystectomy is used, that is, excision of the gallbladder with calculi. If many large stones have formed in the bladder, they perform abdominal surgery, remove the organ and drain the ducts. Now that you know what kind of disease is cholelithiasis, you understand its seriousness.