One of the pathological conditions that are often diagnosed by gastroenterologists and require serious therapy is stagnation of bile. Symptoms of this syndrome indicate problems in the work of the liver, which produces this substance, and the gallbladder, which is a reservoir for collecting bile.
Physiology
Before proceeding with the description of the symptoms of stagnation of bile and treatment of this pathology, you should start with a brief anatomical excursion.
It is known that, after eating, the fats that enter our body break down, but in order for all lipids to be emulsified and all vitamins to be absorbed, in addition to the gastric juice and enzymes produced by the pancreas, acids and salts, the main components of bile, are required. They enter the duodenum from the gallbladder, where the digestive process and hydrolysis of fats continue.
What is the danger?
If bile stagnates and does not arrive in a timely manner in the intestinal section, then:
- Enzyme activity is significantly reduced, which interferes with the complete breakdown of fats. Excessive amounts of lipids enter the bloodstream, preventing the transformation of glucose into glycogen, which, in turn, is fraught with the development of diabetes mellitus.
- With symptoms of stagnation of bile in the gallbladder, there is a risk of accumulation of excess cholesterol, which is present in the composition of bile itself. The result of this violation is hypercholesterolemia and the progressive development of atherosclerosis.
- Without proper treatment, stagnation of bile, the symptoms of which are described in detail in the next section, leads to secondary cholecystitis or gallstone disease.
Often, patients with bile stasis are diagnosed with inflammation of the gastric mucosa, since the digestive tract is regularly exposed to acids that enter the esophagus back from the duodenum. This most often happens with chronic duodenogastric reflux, which occurs with a weakened cardiac sphincter. Symptoms of stagnation of bile can also signal biliary duct fibrosis, which doctors call sclerosing cholangitis.
With a failure in the circulation of bile acids, not only the absorption of fats, but also vitamins, which by their nature are fat-soluble substances, deteriorates:
- retinol (vitamin A);
- ergocalciferol (vitamin D);
- tocopherol (vitamin E);
- phylloquinone (vitamin K).
Vitamin deficiency can result in various health problems. For example, with a lack of retinol, twilight vision worsens, a small amount of vitamin K threatens to decrease blood coagulation, and a deficiency of vitamin D entering the body leads to osteomalacia - a decrease in mineralization and softening of bone tissue. In addition, hypovitaminosis interferes with the absorption of calcium, which makes it more loose and is an excellent condition for the development of osteoporosis.
Another potential threat, as stated by bile stasis symptoms, is an increase in intestinal acidity. In a healthy person, bile, which contains calcium cations, reduces the acidity of the stomach contents, but with cholestasis, an acid-base imbalance of the gastrointestinal tract occurs, as a result of which ascites can develop.
In the initial stages of cholestasis, any clinical manifestations are very rare. The sequence of occurrence of signs of the disease and their intensity largely depends on the cause and characteristics of the hepatobiliary system of the body in a particular case.
Characteristic manifestations
Common symptoms of bile stasis in the gallbladder for most patients are itchy skin and discoloration of feces. It is believed that the epidermis itches with cholestasis due to an increase in the concentration of bile acids in the blood. They enter the blood plasma due to damage to hepatocytes by chenodeoxycholic acid. The feces with this syndrome acquire a characteristic discoloration as a result of a deficiency of bilirubin, a bile pigment, which in a healthy person oxidizes into stercobilin and stains feces in a dark color, and urine in a light yellow color. With stagnation of bile, urine also changes color, becoming darker, since the amount of urobilin in its composition increases.
Typical symptoms of bile stasis in the liver are dyspeptic disorders. Diarrhea, constipation, constant nausea - manifestations inherent in this condition. Since bile acids are important for intestinal motility, their lack leads to constipation. The cause of diarrhea, on the contrary, is an increased content of unsplit lipids in excrement or a bacterial imbalance in the intestinal lumen.
Among the common symptoms of bile stasis, it is worth noting painful sensations localized in the right hypochondrium, upper quadrant of the abdomen. The pains are dull, paroxysmal in nature, can radiate to the upper back of the body, giving back to the clavicle, shoulder or shoulder blade.
In addition, with cholestasis, patients experience frequent dizziness, feel weak. Due to stagnation of bile, the liver increases in size, the pressure in the portal vein rises. In the advanced stages of the disease, accompanied by cholestasis, hair loss (alopecia) is possible as a result of a deficiency of triglycerides.
Common symptoms of stagnation of bile
Drugs for the treatment of this disease are selected depending on the characteristics of its course. Indeed, in addition to the main clinical manifestations, other changes can be observed in patients. For example, with cholestasis, jaundice may occur. Despite the fact that this symptom is observed much less often than the above signs of cholestasis, it deserves special attention. Against the background of a high content of bilirubin in the blood, the epidermis, sclera of the eyes and mucous membranes become yellowness.
In addition, sometimes patients have spots on the eyelids - xanthelasma. In children, the manifestation of bile stasis also includes the formation of xanthomas - focal skin formations, which are small inclusions of cholesterol. Most often, xanthomas appear around the eyes, under the chest, on the neck of infants. Some symptoms of bile congestion in a child can be caused by a lack of essential polyunsaturated acids, including linoleic, linolenic, arachidonic. In particular, a deficiency of these substances leads to dermatitis, stunted growth, and impaired development of the peripheral nervous system.
If a patient, in addition to cholestasis, has a history of other diseases of the digestive system and gastrointestinal tract, there is a possibility of his heartburn. Stagnation of bile is characterized by a constant feeling of bitterness in the mouth and dryness, and often an unpleasant odor arises due to poor digestion and absorption of proteins. Since bile is designed to break down the proteins and nitrogen bases contained in the incoming products, its excess provokes the appearance of an unpleasant odor. The symptoms of stagnation of bile after surgery on the gallbladder often add a bitter belching.
If there is a fever with cholestasis, it is most likely a bacterial infection. Sepsis, phlegmonous or gangrenous cholecystitis often develops after endoscopic diagnosis.
What causes bile congestion
Gastroenterologists consider the destruction of hepatocytes as a result of cirrhosis of the liver (primary biliary or alcoholic) to be the main cause of cholestasis. Such stagnation is called hepatocellular. Another group of factors includes liver damage with infections or parasites, including:
- viral hepatitis;
- hepatic form of tuberculosis;
- opisthorchiasis;
- amoebiasis;
- giardiasis.
Symptoms of bile may also be caused by toxic effects on the liver. Aggressive effect on the gland can be exerted by certain components of drugs, including sulfonamides, penicillin group antibiotics, analgesic substances, hormones.
The development of cholestasis occurs in the presence of benign or malignant tumors, metastases. Among the reasons for which stagnation of bile occurs, also include:
- dyskinesia and kink of the gallbladder;
- gallstone disease;
- inflammatory process in the neck of the gallbladder;
- cystic formations of the bile ducts or their compression by a tumor localized in the pancreas;
- narrowing of the sections of the hepatic duct;
- failures in the work of the sphincters of Oddi, Lutkens, Mirizzy, Geister;
- violations of the endocrine and paracrine mechanisms of the gastroduodenal stage of digestion.
Who is at risk
It is believed that most often the disease occurs in adults. Symptoms and treatment of bile stasis are closely associated with physical inactivity: the less the patient moves, the weaker the metabolic processes in his body and, consequently, the higher the risk of developing gallstone disease and biliary duct dyskinesia.
After cholecystectomy, stagnation of bile, many experts call a typical postoperative manifestation. Such a consequence of surgical intervention occurs due to scarring of the tissue, narrowing the lumens of the biliary canals.
Cholestasis can develop in patients abusing confectionery, pastries, and fat-containing foods. At risk of stagnation of bile are individuals suffering from chronic alcoholism and obesity, who have inherited a genetic predisposition to metabolic disorders.
Medication for cholestasis
Therapy of such a syndrome is based on one of the principles:
- if the cause of cholestasis is known and can be eliminated, conduct etiological, including surgical treatment;
- symptoms of stagnation of bile in adults without a clear root cause are an indication for symptomatic therapy.
If congestion in the liver has not led to inflammation of the biliary ducts, the patient is attributed drugs based on ursodeoxycholic acid. This substance is part of bile, has hepatoprotective, choleretic and choleretic properties. Among the pharmaceutical preparations of this group are most often prescribed:
- Ursofalk.
- "Holacid."
- Livodex.
- "Ukrliv."
- Ursosan.
- Ursodez.
- "Ursokhol."
- "Choludexan".
These drugs are taken in the form of capsules and oral suspensions. They help reduce cholesterol production, inhibit its absorption in the small intestine and, as a result, reduce the likelihood of cholesterol stones. The duration of the course of treatment and the daily dosage, based on the patient’s body weight, is calculated by the attending physician. These drugs have many contraindications, in particular, they are not recommended for cirrhosis, acute cholangitis and cholecystitis, gallstone disease, as well as for liver or kidney failure.
With symptoms of stagnation of bile in the gallbladder, treatment involves the use of choleretic drugs:
- "Holiver."
- "Allohol."
- Hofitol.
- Tsinariks.
- Odeston.
- Heptor.
- "Artichol."
Most of them contribute to increased production of bile, therefore, with acute forms of viral hepatitis, liver dysfunctions and jaundice, such drugs are not used. With caution, they are prescribed for children, since choleretic drugs can cause hives, obstruction of the bile ducts.
In addition to medicines, in the treatment of cholestasis, pharmacy herbal preparations are used. For example, choleretic collection No. 2 includes such medicinal plants as immortelle, yarrow, peppermint, coriander seeds. Children are more often prescribed collection number 3, consisting of calendula flowers, tansy, chamomile and mint leaves. Drinking broth is prepared from phytosborder: on average, 1 cup of boiling water requires 1 tbsp. l medicinal raw materials. The mixture is put on fire and boiled for about 10 minutes, after which it is insisted, filtered and drunk 100 ml each morning and evening before meals for 30 minutes.
Rose hips have similar choleretic properties: infusion can be prepared from dry wild rose fruit at home, and for those who do not want to bother, you can buy it in the Kholosas pharmacy. Adults need to take the drug on an empty stomach, one dessert spoon once a day, and children - with the same frequency, but half as much.
Surgery for stagnation of bile
If treatment with drugs does not bring the expected effect, the patient may be prescribed surgery. Depending on the causes of cholestasis and the localization of stagnation of bile, patients undergo such operations:
- removal of stones and calculi from the bile ducts using a laparoscope (endoscopic lithoextraction);
- removal of a cystic or cancerous formation that prevents the outflow of bile;
- stenting of the biliary tract;
- dilatation (balloon expansion) of the lumen of the bile ducts;
- installation of drainage in the common bile duct;
- correction of the work of the sphincter of the gallbladder;
- cholecystectomy.
Symptoms of bile stasis after removal of the gallbladder in most cases return again, therefore, cholecystectomy is the most radical treatment that is resorted to in advanced cases. With bile congestion in a baby due to biliary atresia, a liver transplant may be necessary.
Alternative treatment
Alternative therapies for cholestasis are quite diverse. In addition to taking medication, many doctors recommend treating with folk remedies in parallel. With the symptoms of stagnation of bile, most of the presented recipes cope without much difficulty:
- Fresh juice. At home, for 1-2 months you should drink 100-150 ml of mixed in equal proportions juices from apples, beets, carrots. You need to take juices an hour after eating.
- Apple vinegar. One tablespoon of this product is added to a cup of water. They drink liquid without sugar, and if you want to sweeten the drink, you can put one teaspoon of honey.
- Mummy. For 10-14 days, you need to drink the mummy tablets dissolved in water. 0.2 g of mummy is used per half liter of water. The medicine is drunk before meals in several doses throughout the day. The general course of treatment for the liver with symptoms of bile stasis is at least three months. In this case, after two weeks of use, you need to take a 5-7-day break. Before using this tool, you must always consult a doctor, since the mummy with such consumption can cause diarrhea and high blood pressure.
With cholestasis, patients are often advised to eat persimmons - this fruit contains vitamin C, beta-carotene and manganese, which is a cofactor of superoxide dismutase and is involved in the gluconeogenesis of amino acids and cholesterol. In addition, in persimmons there are many antioxidant enzymes that increase the stability of the mucous membranes. No less often, with stagnation of bile, it is recommended to use pomegranate. But you should not forget that at the same time as choleretic properties, it has a fastening effect and promotes the development of constipation.
For patients with cholestasis, homemade decoctions of herbs that have long been used to treat diseases of the hepatobiliary system will be useful. These include the following plants:
- smokiness;
- immortelle is sandy;
- three-leaf watch;
- corn silk;
- knotweed;
- hernia is naked;
- Arnica Alpine.
Nutrition basics
With stagnation of bile, a mandatory measure of treatment is a diet. Without dietary restrictions, which are clearly described in the diet "Table No. 5", medicines and folk remedies will not give the expected therapeutic effect. It is necessary to make adjustments to the daily diet immediately after the diagnosis is established. The main principles of the diet for cholestasis are the need:
- Exclude any fatty foods, especially animal products, including pork, lamb, butter, whole cow's milk, sour cream, rich broths.
- Refuse the use of canned and pickled products (sausages, smoked products, pickles, semi-finished products, snacks, etc.).
- Minimize the consumption of flour and confectionery.
The diet of a patient suffering from bile congestion should consist of fresh vegetables and fruits (heat treatment is allowed for gastrointestinal diseases), lean meat, fish, seafood, and legumes. To replenish the fat balance, it is advisable to use walnuts, almonds, flaxseed, pumpkin seeds. On a side dish, a person with cholestasis is better to eat brown rice, buckwheat, oatmeal or barley porridge.