👰 ⚗️ 🚻 Postcholecystectomy syndrome: treatment, symptoms and diagnosis 💅🏽 🐢 🧓

Postcholecystectomy syndrome (PCES) - what is it? Some believe that this is some specific disease. No, it is not. This is a whole complex of clinical manifestations that can be observed either after removal (resection) of the gallbladder (GI), or as a result of any other surgical measures carried out on the bile ducts. Moreover, the syndrome can form immediately after surgery, and may occur after a couple of months or years.

On a note! PCES develops more often in women than in men.

Sometimes patients manifest manifestations of pathology, which were observed before the operation, but new ones may also appear. Moreover, the symptoms of postcholecystectomy syndrome and the treatment of the disease directly depend on the root cause of the pathology and those changes that have occurred in the biliary system.

On a note! Resection of the pancreas is not always the cause of suffering for patients. Sometimes this symptomatology may be associated with pathologies of the stomach, liver, 12 duodenum or pancreas.

Classification of postcholecystectomy syndrome

PCES are divided into three groups:

In no way associated with resection of the GP. Just such symptoms can be caused by pathologies of a concomitant nature.
Directly associated with such surgical intervention as removal of the gallbladder. It can be suture granulomas, postoperative pancreatitis or injuries of the bile duct.

Malfunctions of a motor nature (for example, spasm of the sphincter of Oddi or dyskinesia).

Possible causes of PCES

Causes of postcholecystectomy syndrome:

Violations of the biliary system (in the distribution of bile).
The appearance of some neoplasms of a muscle nature in the area of conjugation of the bile duct and duodenum (spasm of the sphincter of Oddi).
Dysbacteriosis
Violations of the tone and motility of the biliary tract (GWP), their dyskinesia.
Accumulation of fluid in the cavity formed after surgery.
The presence of calculi in the bile ducts.
12 duodenal infection.
A cyst of the common bile duct, which is its expansion. This anomaly merges with the pancreatic duct.
Liver disease (e.g., hepatitis or cirrhosis).
Digestive problems.
Incorrect preoperative preparation of the patient.
Errors made by surgeons during surgery (for example, trauma to the vessels of the gallbladder or its ducts).
Incorrect diagnosis.
Failure in the functioning of the PI (for example, a violation in the process of outflow of bile into the intestine or a decrease in its amount).
"Occupation" of the digestive tract by pathogenic microflora.
Violation of the circulation of bile, when it can not get through certain ducts into the duodenum 12, this may be due to their blockage or partial narrowing.
Pathologies that occurred either before surgery on the gastrointestinal tract, or developed after (for example, pancreatic pancreatitis, duodenal ulcer, duodenogastric reflux, characterized by the reflux of intestinal contents into the stomach, irritable bowel syndrome).

Symptomatology

If any symptom (from the following) appears, immediately seek help from a medical institution where you will be fully diagnosed and prescribed the necessary treatment:

Repeated bouts of pain (in the right hypochondrium or epigastric region, extending either to the scapula on the right or to the back), which last about 20 minutes or more. Moreover, the intensity of pain increases at night or after the next meal.
Violations of the digestive tract.
Diarrhea, manifested in the form of loose 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 with their expenditure), developing hypovitaminosis.
Belching with a bitter aftertaste.
The accumulation of digestive gases in the intestines in excess (flatulence).
"Rumbling and bubbling" in the stomach.
Heartburn.
The lack of trace elements.
Itching of the skin.
Rapid weight loss (stage 1 - loss of the order of 5-8 kg; stage 2 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 process of 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

Briefly about the postcholecystectomy syndrome, and to be more precise, about the types of pain that can be:

Pancreatic in nature. A malfunction in the work of the Westphal sphincter provokes pain, which ensures the separation of the duodenum and ducts that are 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.
Gall nature. Disorders in the work of Faterov's papilla provoke pain, through which pancreatic juice and bile enter the duodenum. The pain is localized in the hypochondrium on the right and in the upper abdomen, it can be given to the shoulder blade on the right and in the back.
Gall-pancreatic nature. 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 backflow of intestinal contents through the ducts) pain surrounding the whole body appears.

Diagnostics

The treatment of postcholecystectomy syndrome largely depends on the correct diagnosis. When a patient visits a medical institution, the doctor attentively listens to all complaints, collects an anamnesis (that is, information about past illnesses, hereditary predispositions, as well as diet and diet) and a 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.
Biochemical analysis of plasma, which helps to determine the amount of lipase, bilirubin, enzymes (amylase) and alkaline phosphatase.
Ultrasound of the abdomen.
X-ray examination of the stomach with barium.
SKT (spiral computed tomography), which gives an accurate picture of the state of blood vessels and organs in the abdominal cavity.
Gastroscopy to rule out any gastrointestinal pathology.
ERCP (endoscopic retrograde pancreatocholangiography). A study that allows you to observe the ducts of the pancreas and bile ducts using an x-ray machine.
ECG to rule out disturbances in the functioning of the heart muscle.
Scintigraphy. The method allows you to determine the presence (or absence) of violations in the circulation of bile. Radioactive isotopes are introduced into the patient’s body, emitting certain radiation. As a result, it becomes possible to obtain a two-dimensional image.

On a note! If there is not enough information to make a diagnosis, then the patient may undergo diagnostic surgery. They do this extremely rarely.

Therapy

Treatment of PCES (postcholecystectomy syndrome) with the help of medications:

Antispasmodics to relieve pain (for example, No-Shpa or Spazmalgon).
Preparations of a choleretic nature, contributing to the formation of bile and its outflow ("Cholenzym", "Allohol" or "Nicodin").
Cholinergic anticholinergic drugs.
Preparations containing enzymes that improve the digestion process (for example, Hermitage, 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 that well stimulate the motor function of the digestive tube and prevent the formation of waves that interfere with normal peristalsis (Motilium, Trimedat or Neobutin).
Hepatoprotectors that have a positive effect on the liver.
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, Intetriks, Stopdiar or Enterofuril).
Do not forget about multivitamin or vitamin complexes.
Nitroglycerine. It relaxes the smooth muscles of the bile ducts (for example, normalizes the work of the sphincter of Oddi) and the entire gastrointestinal tract.
Medicines included in the antacid group. They neutralize the hydrochloric acid present in the gastric juice and, thereby, contribute to the normalization of acidity in the stomach.

In addition to therapy with medications, the doctor gives recommendations regarding possible physical exertion (prescribes exercise therapy), diet and diet, and the possibility of using certain recipes of alternative medicine. Modern treatment of PCES may also involve surgical intervention. This is possible, of course, if there is significant evidence.

On a 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).

ethnoscience

Herbal medicine can significantly alleviate the condition of a patient suffering from PCES after removal of such an important organ as the gall bladder. Remember: all activities related to the use of traditional medicine recipes should occur in parallel with the main drug therapy. Here are some simple methods for treating postcholecystectomy syndrome with herbs:

Collection number 1. It is used to restore the biliary tract. Mix grass with cinnamon, hop cones, calendula flowers and valerian root in a 2: 1: 2: 1 ratio. How to brew is described below, immediately for three fees. Use 2-3 times a day for 1/3 cup. The course of therapy is about 1 month.
Collection number 2. Recommended to eliminate the inflammatory process in the bile ducts and stagnation of bile. Mixes calamus root, corn stigmas, celandine grass, bird highlander and centaury in a ratio of 3: 2: 1: 2: 2. Take tincture 2 times a year (the duration of one course is 30 days).
Collection number 3. Suitable if you are concerned about the poor functioning of the biliary tract and sphincter of Oddi. The 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 (about 20 minutes) or after (after 60 minutes). The course of therapy of each collection is not more than 1 month.

In combination with drug treatment of postcholecystectomy syndrome, you can drink infusions of herbs that help relieve inflammation and spasms, and also have sedative and immunomodulating effects. For example, an excellent remedy is a decoction made from calendula flowers, birch leaves, knotweed and rose hips.
Another recipe for coping with PCES. The rosehips, the root of the bird highlander and cyanosis, the nettle and the golden drake are mixed in the ratio 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 for the postcholecystectomy syndrome, for example, 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 twice a day for ½ cup.
To normalize the digestive tract, it is recommended: in case of diarrhea - mix quince syrup (50 ml) with the juice of horsetail field (50 ml) and drink this portion in three doses during the day; in case of constipation, drink one teaspoon of vegetable oil three times a day (better than sesame oil).
Shredded 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 "Ursosan"

The tool does an excellent job with PCES. The main active component of the drug is ursodeoxycholic acid. In the pharmacy network, the drug is presented in the form of hard capsules, inside of which is a white powder.

For prophylactic purposes of repeated cholelithiasis after PCES, patients are prescribed one capsule (250 mg) 2 times a 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, you do not need to chew the capsules. Drinking recommended a large amount 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 intestine and bile ducts;
cirrhosis of the liver;
gallstones;
certain malfunctions in the functioning of the pancreas, liver and kidneys;
chronic hepatitis;
the lack of ZhP;
pregnancy;
pancreatitis
lactation.

Important! Ursosan can be taken only as directed by a doctor. Self-medication is dangerous to your health.

Nutrition at PCES

Recommendations regarding the regimen and diet for post-cholecystectomy syndrome (symptoms and treatment of exacerbations have been described above):

Drink about 2 liters of water per day.
Calorie intake of foods should not exceed 300 kcal.
It is necessary to refuse sharp, spicy, acidic and with pronounced choleretic action of products, as well as fatty and fried foods.
The amount of fat per day should be about 50-60 g; proteins - 100 g, and carbohydrates - 400 g.
Do not forget to include B and A vitamins in your diet.
Eat during the day you need about 5-7 times (in small portions).

Products that you can eat:

rye bread and wheat;
soups: beetroot soup, borsch;
inedible pastries, cookies, dry biscuit;
low-fat beef, lamb, chicken, turkey and fish;
acidophilus, kefir, dumplings, 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;
squash caviar, gravy;
dill, parsley;
vanillin, cinnamon;
any fruits and berries (non-acidic only), dried fruits;
marmalade, jelly, chocolate-free candies, candy, honey, jam (if sorbitol or xylitol is used instead of sugar).

Products to be discarded:

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 cottage cheese with a high percentage of fat content;
mushrooms, radish, legumes, spinach, garlic;
black coffee, cold drinks, cocoa;
sorrel;
spicy and fatty snacks;
chocolate;
horseradish, mustard;
pickled vegetables;
ice cream, cakes and pastries.

In custody

Now you know a lot about postcholecystectomy syndrome (causes, diagnosis and treatment). We hope this information will help you deal with this ailment and continue to enjoy life. Health to you and your loved ones!

Postcholecystectomy syndrome: treatment, symptoms and diagnosis