Stones in the gallbladder, treatment, surgery, drugs. Stones in the gallbladder: treatment without surgery Gallstones in the gallbladder symptoms treatment without surgery

Do you know which disease is in no way inferior in prevalence, and perhaps even surpasses the disease of cardio-vascular system? This is cholelithiasis, or cholelithiasis: to remove stones from the gallbladder, about 600,000 Russians annually fall under the surgeon's knife.

This procedure is surpassed in frequency only by appendicitis operations. We will talk about the causes, signs and correction of the "popular" ailment in the article.

Gallstone disease refers to the formation and accumulation of stones in the cavity and ducts of the gallbladder, which occurs due to a metabolic disorder in the body.

The epicenter of the problem is the gallbladder. It is adjacent to the liver and is a kind of reservoir where liquid bile accumulates, which is synthesized by the liver. The material for the formation of stones, which are also called gallstones, are cholesterol crystals and occasionally calcium salts of a pigment-lime nature. This is a very long process - it can take from 4 to 20 years.

The gallbladder is not the only place where stones are found; they can also accumulate in the liver and hepatic duct trunk. The structure, size and shape of the calculi are very diverse. When one or more stones block the duct that carries bile from the gallbladder to the gallbladder small intestine, a person is tormented by colic. GSD often causes inflammation in gallbladder(cholecystitis), because the stones injure its mucosa.

Pathology affects the population of large industrial cities. It is believed that this is where people abuse too heavy for digestive system food. As a rule, the disease affects women 3-8 times more often than the representatives of the stronger sex.

Symptoms of gallstones

When stones appear in the gallbladder, the disease does not make itself felt on average for 6 to 10 years, that is, it is in a latent form. How soon characteristic signs appear depends on the number, parameters and location of stones.

Main features cholelithiasis the following:

1. Pain in the region of the liver and under the ribs on the right side. The nature of the pain is paroxysmal, boring, stabbing.
2. Nausea, which in some cases leads to vomiting.
3. Belching with air.
4. A bitter taste on the tongue, which is a consequence of the flow of bile into the stomach.
5. Increased gas formation, dyspepsia, colorless feces.
6. Rapid fatigue and general malaise.
7. Increased body temperature.
8. Jaundice.

An attack of biliary colic can cause the use alcoholic beverages, food that is difficult to digest, fried foods, abuse of spicy spices, heavy physical exertion and severe stress. First, the pain appears on the right side, in the area under the ribs, and gradually begins to radiate to other parts of the body. The object of painful sensations can be the right shoulder blade, lower back, right half of the neck. Sometimes an attack of biliary colic is mistaken for angina pectoris, since the pain gives off to the sternum. In fact, the gallbladder and its ducts, constrained by spasms, become the epicenter of pain. This happens when the calculi caused severe irritation of the mucous walls of the bladder.

A person is forced to experience even more painful sensations when stones, moving along the bile ducts, block the lumen of the bile duct. If the blockage is complete, the liver will soon increase in size and its capsule will stretch. This violation will cause constant dull pain and a feeling of heaviness under the ribs on the right. Outwardly, such changes are manifested by clinical symptoms of obstructive jaundice (yellowed skin and eye sclera) and discoloration of feces.

It happens that biliary colic goes away on its own. This usually happens as soon as the stone passes from the bile duct into the cavity of the small intestine. The duration of the attack, as a rule, does not exceed 6 hours. To alleviate the suffering of the patient, he can apply a heating pad to the area of ​​\u200b\u200bthe right hypochondrium. If the stone is too large for the bile duct, it will prevent the flow of bile. The pain will only intensify - this indicates the need for immediate medical attention.

Very often, vomit mixed with bile indicates gallstone disease, and vomiting does not bring relief at all, since it is just a reaction to irritation of the duodenal mucosa.

Stones in the gallbladder. Reasons for the development of gallstone disease

Healthy bile is a liquid, without any impurities, a substance from which calculi cannot form. Pathological formations appear against the background of the following factors:

• high concentration of cholesterol in bile;
• stagnation of bile as a result of a violation of its outflow;
• infectious- inflammatory process in the gallbladder, which is a prerequisite for the development of cholecystitis.

The formation of gallstones is based on a pathological change in bile with an imbalance between cholesterol and acidic substances in its composition.

An excess of cholesterol in bile is seen in the following reasons:

1. Abuse of food high in animal fats.
2. Decreased synthesis of bile acids in the liver.
3. Obesity.
4. Long-term use of oral contraceptives, which contain estrogen (in women).
5. A history of other serious diseases such as diabetes mellitus, cirrhosis of the liver, Crohn's disease, allergies.

All these factors do not have the best effect on the gallbladder, inhibiting its contractile function. On this soil, the so-called cholesterol flakes begin to settle inside the organ, from which calculi are later formed.

Violation of the outflow of bile and its stagnation are due to such reasons:

1. Dyskinesia biliary tract(disorder of contractile activity).
2. Flatulence (high pressure occurs in the gastrointestinal tract, which prevents the normal outflow of bile).
3. Operations on the gastrointestinal tract (for example, vagotomy).
4. A lifestyle devoid of sports and active pastime.
5. Pregnancy (the fetus in the uterus compresses the organs of the peritoneum and disrupts the outflow of bile).
6. Unbalanced diet with long intervals between main meals.
7. Complete refusal of food.
8. A sharp loss of 5 or more kilograms as a result of a rigid diet.

The mechanical causes of stagnation of bile include the following factors:

1. The formation of adhesions, tumors in the gallbladder.
2. Swelling of the walls of the gallbladder.
3. Bending or narrowing of the bile ducts.
4. Congenital anomalies of development: cysts of the main duct, protrusion of the walls of the duodenum 12.

Infection and inflammation of the gallbladder has a significant impact on problems with the outflow of bile. This often leads to the development of cholecystitis and cholangitis, which are based on acute and chronic inflammatory reactions in the gallbladder and its ducts.

Stones in the gallbladder: composition, shape and quantity

When the natural movement of bile stops in the gallbladder, cholesterol plaques settle on the mucous walls of the organ and form "sand", which subsequently becomes the material for the formation of gallstones. Due to the diversity of stones, they were classified into groups.

By structure gallstones there are:

• homogeneous - are formed when pure cholesterol, mucus clots and foreign objects (for example, fruit seeds) "stick together";
• complex - have a core, body and bark. The nucleus is formed from the substance bilirubin.

According to the chemical composition, gallstones are divided into the following types:

• cholesterol;
• calcareous;
• pigment;
• mixed type.

Note that stones with a homogeneous chemical composition are extremely rare. Basically, there are several components in the composition of the stone, and the largest share belongs to cholesterol.

Depending on the structure, gallstones are:

• crystalline;
• layered.

According to the consistency, gallstones are distinguished:

• hard;
• waxy.

The size of the calculi can be completely different - their parameters vary from a few millimeters to several centimeters. Often, a gallstone is the size of a hazelnut or a chicken egg. It happens that the entire cavity of the gallbladder is occupied by one large stone weighing up to 80 g. The shape of the stones can also be completely different. Small stones, the diameter of which does not exceed 1 - 2 mm, can pass through the bile duct, which cannot be said about larger stones. When a large stone blocks the duct, there are corresponding symptoms and complications that have been described above. The number of stones concentrated in one gallbladder is different in each case. IN medical practice a case is known when about 7000 stones were contained in one gallbladder.

Stones in the gallbladder. Complications of gallstone disease

If not taken necessary measures for the treatment of gallstones, the condition of a sick person may be aggravated due to the following complications:

1. Acute cholecystitis.
2. Blockage of the bile duct, which is the basis for the development of infection, chronic cholecystitis and pancreatitis.
3. Rupture of the gallbladder and, as a consequence, peritonitis.
4. Penetration of large gallstones into the intestine with subsequent blockage.
5. Increasing risk of development oncological disease gallbladder.

How to treat gallstones: diagnostic methods

Ultrasound helps to detect stones in the gallbladder, and large stones can even be felt with your fingers. Usually, on ultrasound, the doctor receives all the information he is interested in about the number, size and location of the accumulation of stones. At the same time, you can assess the real state of the gallbladder, find out if there is inflammation or not.

When ultrasound is not enough to make a confident diagnosis, doctors resort to other, more complex diagnostic methods, the main ones being the following:

• oral cholecystography - the method consists in an x-ray examination, for which the patient takes a special preparation that contrasts bile;
• retrograde cholangiopancreatography - x-ray examination, involving endoscopy and the introduction of a contrast agent into the ducts of the gallbladder.

How stones are removed from the gallbladder

The latest achievements of conservative medicine make it possible to rid the patient of calculi and at the same time preserve the organ along with the ducts. Today, doctors practice three main ways to treat gallstone disease. Let's consider each of them in more detail.

Stones in the gallbladder. Oral litholytic therapy

It's nothing but the dissolution of stones in a medical way. For this, the patient is prescribed drugs Ursosan and Henofalk. To understand how these remedies help dissolve gallstones, you need to look into their composition. The active components of Ursosan and Henofalk - ursodeoxycholic and chenodeoxycholic acid, respectively - have the ability to lower the concentration of cholesterol in bile and at the same time contribute to an increase in the level of bile acids. The latter are active against stones, and gallstones gradually begin to decrease in size.

The prerequisites for the implementation of the litholytic method of treatment are the following factors:

1. The patient is dominated by calculi of cholesterol origin.
2. The stones are small (up to 15 mm in diameter) and fill only about half of the gallbladder.
3. The gallbladder is able to fully contract, and its ducts have normal patency.

Almost all diseases of the gastrointestinal tract and kidneys are an obstacle to litholytic therapy. The duration of the course of treatment varies from six months to 2 years. All this time, the patient regularly undergoes ultrasound. The effectiveness of the method ranges from 40 to 80% - the success of treatment depends on the size of the stones and the dose of the drug. After the end of therapy, it remains necessary to take Ursosan and Henofalk in maintenance doses, otherwise the concentration of cholesterol in the blood will increase again.

Stones in the gallbladder. Ultrasonic extracorporeal lithotripsy

The method is based on the crushing of stones in the gallbladder. Solid clots are crushed under the onslaught of a shock wave up to 3 mm in diameter and enter the duodenum 12 through the bile ducts. Extracorporeal lithotripsy is often supplemented with oral litholytic therapy, when small fragments are dissolved with special drugs.

This method of treatment is practiced among patients who have a small number of stones (up to 4 pieces). The effectiveness of therapy increases if the calculi consist mainly of cholesterol and are large in size. As a rule, the duration of treatment is 1-7 procedures. Extracorporeal lithotripsy is contraindicated in people with poor blood clotting and sluggish inflammatory pathologies of the gastrointestinal tract.

Despite the effectiveness of the method, the following side effects were noted:

• the likelihood of blockage of the bile ducts;
• wound of the mucous membrane of the gallbladder with uneven edges of stones under the influence of vibration.

These adverse events can cause inflammation and the onset of adhesions in the gallbladder.

Stones in the gallbladder. Percutaneous cholelitholysis

This invasive method of correction of cholelithiasis is used when gallbladder stones cannot be eliminated without surgery. Percutaneous cholelitholysis is powerful and very effective method fight not only with cholesterol stones, but also with stones of a different origin. The operation can be performed at any stage of the development of the disease with any degree of its severity. clinical picture. Indications for cholelitholysis are often repeated painful attacks due to the large size of gallstones.

During the procedure, a catheter is inserted through the tissues of the skin and liver into the cavity of the affected organ, and then 5-10 ml of methyl tert-butyl ether, a substance that breaks down abnormal formations, is injected through it with drops. In about 1 month of the course of the patient, 90% of the stones can be eliminated.

The methods described above show how to effectively remove gallstones from the gallbladder without serious surgical intervention. There is another way to treat gallstone disease, which has become especially popular recently.

Stones in the gallbladder. Cholecystectomy

For the treatment of cholelithiasis complicated by cholecystitis, cholecystectomy is used - the removal of the gallbladder along with the stones filling it. Since cholecystitis develops due to a metabolic disorder, which directly affects the combination of components in the composition of bile, dissolving or grinding the stones will not save the patient from the problem - after some time, the stones will appear again. The bladder is removed during laparoscopic surgery - it is removed through small incisions in the anterior wall abdominal cavity using a tube with a video camera (laparoscope).

This method has several "advantages" compared to open surgery:

1. The patient recovers quickly after the operation.
2. In places of incisions on the abdomen, barely noticeable scars remain.
3. Development risk postoperative hernia extremely small.
4. The cost of laparoscopic cholecystectomy is relatively low.

Contraindications to the prompt solution of the problem are:

• obesity 2 and 3 degrees;
• stones of very large size;
• operations on the digestive tract in the past;
• purulent lesion of the gallbladder;
• pathologies of the cardiovascular and respiratory systems;
• 3rd trimester of pregnancy.

Unfortunately, cholecystectomy will not save the patient from the manifestations of cholelithiasis in the future. The basis of the formation of calculi is the "unhealthy" chemical composition of bile. This problem remains even after the removal of the organ affected by stones.

After such an operative intervention, many complain of pain in the right hypochondrium and liver, a feeling of bitterness in the tongue, metallic taste food. In addition, there may be problems associated with the dysfunction of organs such as the liver, pancreas, duodenum. After removing the reservoir for the accumulation of bile, it freely enters the intestine, while maintaining the defects of its chemical composition. On this basis, the risk of developing serious inflammatory reactions in the digestive tract increases.

Diet for gallstones

Healthy eating habits are of great importance in gallstone disease: in many ways, the patient's condition is determined by what he eats. It is recommended to eat often, eating 5-6 times a day. When modest-sized portions enter the stomach, the choleretic effect increases, an active outflow of bile occurs, which prevents its stagnation. A large amount of food eaten at one time causes the muscles of the gallbladder to contract instinctively, and this leads to an aggravation of the disease.

Nutrition with stones in the gallbladder should be balanced: daily the body needs to receive a sufficient amount of animal protein and a moderate amount of animal fats, since they are very difficult to digest. It is best to eat vegetable fats. It is very useful to eat foods that contain magnesium.

What to eat with gallstones

The following foods should regularly appear on the plate of a person suffering from gallstone disease:

• lean meat and fish;
• cereals (priority is buckwheat and oatmeal);
• cheese, cottage cheese, milk, the fat content of which does not exceed 5%;
• a variety of fruits and vegetables: pumpkin, carrots, cauliflower, zucchini, watermelon, prunes, apples;
• homemade compotes, fruit drinks, mineral water, quince and pomegranate juice.

What not to do with gallstones

In order not to provoke the development of gallstone attacks, doctors strongly recommend that patients refuse certain foods. In the "black" list:

• fatty meat and fish, lard, offal;
• sausage, smoked meats, canned and salty foods;
• butter (you can only add a little to the porridge);
• fried foods with a pronounced sour or spicy taste;
• legumes, radishes, cucumbers, onions, garlic, eggplants, radishes;
• fatty broths;
• coffee, cocoa, alcoholic drinks.

Prevention of the development of cholelithiasis

To insure yourself against the formation of gallstones, you need to remember and try to follow a few rules:

1. Do not eat a lot in one meal.
2. Avoid foods that are high in fat and cholesterol.
3. Get rid of excess weight through regular exercise and a balanced diet.
4. Put in order the metabolism in the body: reduce the synthesis of cholesterol by the liver and activate the secretion of bile acids. For this, drugs such as Liobil and Zixorin are usually taken (only after a medical examination as prescribed by a doctor).

When the gallbladder "asks" for help: alarming symptoms. Video

If stones are found in the gallbladder, the doctor prescribes further treatment tactics individually for each case. Depending on the size of the stones and the condition of the patient, crushing and dissolution of stones are recommended, which are non-surgical methods of therapeutic therapy.

Today, medicine offers several different options for how to get rid of gallstones without surgery, each of which has its own advantages and disadvantages.

Medicamentous dissolution

Medical treatment of gallstones without surgery is prescribed only if cholesterol stones do not exceed two centimeters in size.

Therapy is carried out with the appointment of drugs with ursodeoxycholic and chenodeoxycholic acid, which are analogues of bile acids.

Drugs with ursodeoxycholic acid are used to reduce the concentration. These include:

• Ursoholol;
• Ursolizin;
• Ursofalk;
• Ursosan.

The presented funds are used once a day in a dosage corresponding to the weight of the patient. The drugs should not be used if there are inflammatory processes in the biliary tract, liver, kidney dysfunction.

Preparations with chenodeoxycholic acid contribute to the partial (and sometimes complete) dissolution of gallstones. These include:

• Henosan;
• Henofalk;
• Henohol;
• Chenodiol.

Means with chenodeoxycholic acid are contraindicated for inflammation of the intestines, esophagus and stomach, for hepatic and.

Simultaneously with the main drugs prescribed reception medicines aimed at stimulating the contractile function of the gallbladder and producing: Allohol, Liobil, Holosas, Zixorin.

To improve the patency of the bile ducts and establish outflow, it is recommended to take cholespasmolytics: Metacin, Papaverine, Eufillin, Drotaverine.

Important! Calcareous and pigment stones in the gallbladder cannot be dissolved and removed with the help of drug therapy.

Drug therapy has a number of contraindications:

• Pregnancy;
• Concomitant chronic diseases in the gastrointestinal tract;
• Obesity;
• Simultaneous use of estrogen drugs.

The disadvantages of medical non-surgical removal of stones from the gallbladder include the rather high cost of drugs necessary for treatment, a long course of treatment (from six months to 3 years) and a fairly high number of relapses. After the end of the intake medicines the level of cholesterol in the blood rises again, and after a few years there is a possibility of recurrence of stones.

Crushing by ultrasound

This method is based on crushing stones with the help of high impact and vibration of the shock wave. Ultrasonic waves destroy stones, crush them into small particles (particle size - no more than 3 mm), which are then independently removed from the bile ducts into duodenum.

Indications for the use of ultrasound: intended for patients who have a small amount of stones (up to four pieces) of large sizes, without lime impurities in the composition.

Ultrasonic crushing of stones is accompanied by before and after the procedure, so that the doctor can control the process of destruction.

Contraindications:

• Pregnancy;
• Chronic inflammatory processes in the gastrointestinal tract;
• Impaired blood clotting.

Important! In the process of crushing, there is a high probability that a broken off sharp piece of stone can damage the internal walls of the organ.

The patient during the procedure may experience discomfort, pain and discomfort.

Disadvantages of the method:

• Possible damage to the walls of the gallbladder with sharp edges of crushed stones.
• The likelihood of blockage of the bile ducts due to vibration.

After removing the stones with ultrasound, you should go on a strict diet and follow all medical prescriptions, because. there is a risk of further complications in the form of jaundice,.

Laser stone removal is considered the most gentle and progressive non-surgical method.

Indications for the use of the laser: the size of the stones should not be more than 3 mm.

In the process of laser crushing, a puncture is made on the anterior abdominal wall to gain access to the gallbladder. A laser beam is delivered to the impact zone, which begins to split the stones, turning them into small particles that come out on their own. The effect is achieved by carrying out several procedures, the duration of one session is no more than 20 minutes.

Contraindications:

• Age over 60 years;
• Obesity, weight over 120 kg;
• General serious condition of the patient.

Laser removal is accompanied by conduction in order to prevent damage by sharp fragments of the walls of the gallbladder.

Disadvantages of the method:

• The need for special equipment and highly qualified specialists;
• Possible damage to the walls of the gallbladder with sharp edges of stones;
• The likelihood of burns of the mucous membrane with a laser, which can subsequently provoke the formation of an ulcer.
• The laser method is quite popular and very effective.

Note! The use of a laser allows you to save the gallbladder, the procedure does not take much time and is carried out in stationary conditions.

contact method

The contact method was developed relatively recently, and is based on chemical attack on the stones. With this method, all types of stones (not only cholesterol stones) can be removed, while the size and number of stones do not matter.

The essence of the method: through a puncture in the skin, a thin catheter is inserted into the gallbladder, through which a special chemical solvent is introduced in small portions. After - the solvent, together with the dissolved particles of stones, is sucked out of the gallbladder.

The entire procedure is carried out under strict ultrasound and radiographic control.

Disadvantages of the method: invasiveness and duration of the procedure - the procedure can be carried out within 16 hours.

The contact method can be used at any stage of the disease. Its efficiency is 90%.

Laparoscopy

To remove stones from the gallbladder, a method called laparoscopy will help. Stones are removed using an endoscope, while the patient is under general anesthesia.

The essence of the method: through small incisions in the skin, special metal conductors (trocars) are inserted into the gallbladder. After that, carbon dioxide is introduced into the abdominal cavity through the trocars. Through one of the incisions, an apparatus is inserted that transmits the image to the monitor. Focusing on the image, the doctor finds and removes the stone.

After the end of the procedure, special staples are applied to the vessels and ducts of the gallbladder.

The duration of the event is about an hour, the subsequent stay in the hospital is about 1 week.

Contraindications:

• Cardiovascular diseases;
• Excess body weight;
• Pathology of the respiratory system;
• The presence of adhesions on the bile ducts remaining after other surgical interventions;
• Purulent and inflammatory processes in the gallbladder.

Non-surgical removal of stones from the gallbladder involves the use of folk and homeopathic methods of treatment. These methods also show sufficient effectiveness, but should still be used under medical supervision - self-treatment may lead to deterioration.

This article is posted solely for the general educational purposes of visitors and is not scientific material, universal instructions or professional medical advice, and does not replace a doctor's appointment. For diagnosis and treatment, contact only qualified doctors.

Occurs quite frequently and modern medicine offers more than one method of treatment of this disease. Drug treatment does not always bring the desired result, so in such cases I resort to a more radical method - crushing stones in the gallbladder.

Gallstone disease is a disease in which stones form in the gallbladder.

Cholelithiasis (gallstone disease) is a pathology in which stones form in the gallbladder or duct. The size of the stones can be from a couple of millimeters to several centimeters.

The reasons for the formation of the disease include the intake of products in which there is a high content of animal fat and protein. Due to the uncontrolled use of these products, a person’s cholesterol level in bile goes off scale, which leads to poor performance of functions and stagnation.

Bile is a fluid found in the gallbladder cavity that is responsible for the breakdown and digestion of food. The gallbladder is located next to the liver, which produces the production of bile, namely its component - the pigment bilubin. The second main component of the bile fluid is cholesterol, the excess of which provokes the development.

Due to the long stagnation of bile, cholesterol precipitates, from which the so-called "sand" is formed, the particles of which join each other and form (calculi). stones small size(1-2 mm) are able to exit themselves through the bile ducts, and larger ones are already cholelithiasis requiring therapeutic intervention.

Symptoms of cholelithiasis

Heartburn can be a symptom of gallstone disease.

Often, a person is not aware of the presence of cholelithiasis until the sharp manifestations of symptoms that require urgent action. List of common symptoms of this disease:

• acute pain in the place of the right hypochondrium;
• a sharp attack of biliary colic;
• nausea and vomiting;
• elevated temperature;
• yellowness of the skin.

The neglect of the disease can provoke the following complications:

1. infection of the gallbladder;
2. narrowing of the bile ducts;
3. the formation of chronic inflammatory processes leading to diseases such as hepatitis, cholecystitis, duodenitis,.

Methods of treatment of cholelithiasis

Laser crushing of stones is a method of treating cholelithiasis.

Modern medicine practices the following methods of treatment of gallstone disease:

Methods that do not require surgical intervention:

• dissolution of stones with the help of medicines;
• treatment with ultrasonic remote lithotripsy.

Methods with minimal intrusion:

1. crushing stones with a laser;
2. contact chemical litholysis.

Methods requiring surgical intervention:

1. laparoscopy;
2. open abdominal operation;
3. endoscopic cholecystectomy.

Before choosing necessary treatment you need to determine the composition of the stones. By nature of origin, they are: lime, cholesterol, pigment and mixed. Cholesterol stones can dissolve under the action of bile acids (ursodeoxycholic, chenodeoxycholic).

If this is not enough, then it is necessary to crush the stones with ultrasound or a laser, and only then apply acids. Despite the abundance of sparing methods for removing stones, the method of cholecystectomy is still actively used. This definition means removal along with stones. But gradually such operations are replaced by the endoscopic method of removal.

Dissolution of stones with medications

Allochol is a drug that stimulates the production of bile fluid.

This method of treatment is effective only for cholesterol stones, with calcareous and pigment stones, alas, this method does not work. The following medications may be used:

• Bile acid analogues: Henofalk, Henohol, Ursosan, etc.
• Drugs that stimulate the contraction of the gallbladder and the production of bile fluid: Holasas, Allochol, Liobil, Zixorin, etc.

Disadvantages of drug therapy:

1. when you stop taking medications, often (10-70% of cases) there is a repeated return of the disease, since the level of cholesterol again rises strongly;
2. observed side effects in the form and changes in liver tests (AST, ALT);
3. the course of treatment is long, medication is taken for at least half a year, sometimes up to three years;
4. the high cost of medicines.

Contraindications to medical treatment:

• diseases of the gastrointestinal tract: peptic ulcer, ;
• kidney disease;
• obesity;
• period of pregnancy.

Crushing stones with a laser

Stone crushing can be done with a laser.

This procedure is not long, it takes about 20 minutes. The front is pierced abdominal wall, then the laser beam is directed to the required area of ​​the gallbladder and the stones are split.

Cons of laser crushing:

1. in this way, the walls of the gallbladder can be damaged, injuring them with sharp stones;
2. possible abstruction of the bile ducts;
3. a high probability of getting a burn of the mucous membrane, which can later lead to the formation;
4. professional equipment required.

Contraindications:

• the patient's body weight is higher than 120 kg;
• the patient is in serious condition;
• You can not carry out the procedure for people over 60 years old.

Crushing stones with ultrasound

Crushing of stones by ultrasound is used if the patient has no more than four stones.

This method is used if the patient has no more than four stones, up to 3 cm in size, not containing lime impurities.

The principle of action is to act on stones high pressure and vibrations of the regenerated shock wave, in order to grind the formed stones to a size not exceeding 3 mm.

• there is a possibility of blockage of the bile ducts due to vibration waves;
• sharp stones can damage the walls of the gallbladder.

Contraindications:

1. poor blood clotting;
2. period of pregnancy;
3. inflammatory processes and chronic diseases of the gastrointestinal tract: pancreatitis, peptic ulcers,.

Method of contact chemical cholelitholysis

This method fights with all types of stones, regardless of composition, quantity and size. The primary goal of contact chemical cholelitholysis is to preserve the gallbladder. The method can be applied at any stage of a symptomatic or asymptomatic disease.

How the procedure is carried out: with the help of control to the patient through skin covering and the liver, a catheter is inserted into the gallbladder, through which a dissolving liquid (mainly methyl trebutyl ether) is slowly introduced. Experts have confirmed that the gallbladder is resistant to cytotoxic effects this solvent.

The disadvantages of this method include invasiveness (intrusion into the patient's body).

Laparoscopy method

Laparoscopy is a method of dealing with stones in the gallbladder.

Doctors resort to such methods if a patient is diagnosed with such a diagnosis as calculous cholecystitis. The operation takes approximately an hour. Stages of operation:

• general anesthesia is introduced;
• a cut is made in;
• the abdominal cavity is filled with carbon dioxide;
• a tube is inserted into the incision to transfer the image to the monitor of the device;
• the surgeon looks for stones and removes them with metal conductors (trocar);
• staples are applied to the ducts and vessels of the gallbladder.

After the operation, you need to be under observation for about a week. Contraindications:

1. the stones are unacceptably large;
2. obesity;
3. gallbladder abscess;
4. heart diseases;
5. diseases of the respiratory system;
6. the presence of adhesions after other operations.

About stones in the gallbladder - in the thematic video:

Cholecystectomy and laparoscopic cholecystectomy

Laparoscopy and laparotomy in this case means the removal of the gallbladder along with the stones contained in it. A laparoscope is a tube with a video camera that is inserted into one of several incisions in the abdominal cavity (3-4 of them are made during the operation). Next, the gallbladder is removed through a small hole (up to 1.5 cm in diameter). Advantages of laparoscopy:

• short recovery period;
• low cost;
• no big scars.

open open surgery

In the presence of too large stones, a surgical operation is performed.

Surgeons resort to this method for cholelithiasis with severe complications, for too large stones or in the presence of dangerous inflammatory processes.

The operation is performed through a large incision with a diameter of up to 30 cm, passing from the navel to the navel. Flaws:

1. compulsory anesthesia;
2. high invasiveness;
3. the possibility of infection;
4. risk of bleeding;
5. death is possible (with emergency surgery).

Reasons not to remove the gallbladder:

• violation of motility of the muscles of the duodenum;
• bile changes its consistency and does not effectively protect the organ from pathogenic organisms;
• bile acid irritates the mucous layers and, as a result, diseases are possible: gastritis, colitis, etc.;
• the functions of secondary absorption of bile are violated and it is quickly excreted from the body, which negatively affects the digestion process;
• the appearance of pain in the right hypochondrium, bitterness and a metallic taste in the mouth.

Removal of the gallbladder does not guarantee the absence of cholelithiasis, since stones can also form in the bile ducts.

Before resorting to cholecystectomy, you need to try to get rid of the problem with more gentle methods, and only when their ineffectiveness is confirmed, then operate.

Products that remove excess cholesterol:

1. buckwheat and oatmeal;
2. low fat;
3. lean meat and fish;
4. still water, compotes, fruit drinks (at least 2 liters per day);
5. fruits vegetables.

In this article, we will try to understand the causes of gallstones, the first symptoms, risk factors and the possibility of treatment without surgery. We will also touch on the topic of nutrition and try to draw conclusions regarding the operation.

How exactly do gallstones form?

First of all, you need to remember that gallstone disease - is a disease associated with metabolic disorders. This problem appears in people with impaired lipid metabolism and impaired cholesterol metabolism. Bile takes part in the breakdown of fats and brings them to a very small state. If, for example, a person excludes fats from his diet, then the bile will concentrate, which will subsequently lead to the crystallization of stones. The thing is that cholesterol and bilirubin cannot be filtered by the kidneys, so they are excreted exclusively through bile. Under adverse conditions, they are able to settle and form crystals. After that, these crystals begin to turn into real stones, which are dangerous for blocking the ducts. If they are formed, then symptoms are obtained that are immediately very difficult to distinguish from other diseases. If the ducts are clogged, then bile ceases to be excreted, which will inevitably lead to inflammation of the gallbladder.

If you are not sure about the presence of gallstones, then you should go to ultrasound diagnostics which will show the exact result.

Symptoms of gallstone disease:

• Pain in the right hypochondrium radiating to the neck, arm or jaw
• Nausea and bitterness in the mouth
• Constipation, flatulence, loose stools, heartburn
• Yellowing of the skin and eye sclera

These stones are able to reach large sizes (with a quail egg), when the size of the stone reaches 4-5 mm, it becomes larger than the size of the duct and the channel is clogged.
Large stones cannot be dissolved by therapeutic methods Therefore, in such cases, you need to go to the operation. Most often, this results due to negligent treatment of one's health and untimely access to a doctor.

What causes stones to appear?

• Cholesterol and fatty foods
• Constant fasting or irregular eating
• Passive lifestyle
• Metabolic disorders
• Diseases of the liver and digestive organs
• Diseases of the gallbladder
• Frequent drinking and nervous stress

The danger of stones in the body

The biggest danger is the development of all kinds of complications. If your stones grow further, they can form a pressure sore on the surface of the bladder, a fistula, and even an effusion into the intestines, which can lead to detrimental consequences, and even intestinal obstruction. The stones themselves carry with them a great threat not only to the gallbladder, they can endanger other organs, including the pancreas.

Treatment without surgery

It all starts with nutrition, so try to take it very seriously from now on. You need to normalize lipid metabolism, lower cholesterol and purify the blood. Start by following a low cholesterol diet/nutrition. Also, do not forget about the correct use of fats:

• Eat mostly butter fats in the morning
• At lunch fish fat(omega 3-6)
• Eat high-quality vegetable fats in the evening

Adjust your weight and completely give up smoking and alcohol, exercise regularly and go in for sports or just walking.

Nutrition Tips

Should I have surgery if I have gallstones?

If you have 1-2 small stones, there are no problems with gallstones (no blockages), there are no complications from the pancreas, there is no reflux of bile, bitterness and disruption of the stomach, then you can take your time with the operation. You can try to make yourself proper diet Or try dissolving gallstones. But if you have pain and malnutrition, then you need to do the operation.

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Chronic calculous cholecystitis- This is a disease in which stones form in the cavity of the gallbladder, which subsequently cause inflammation of the walls of the gallbladder.

Cholelithiasis refers to common diseases - occurs in 10-15% of the adult population. In women, this disease occurs 2-3 times more often than in men. Cholecystitis is an ancient human disease. The first gallstones were discovered during the study of Egyptian mummies.

Anatomy and physiology of the gallbladder

The gallbladder is a hollow, pear-shaped organ. The gallbladder is projected approximately in the middle of the right hypochondrium.

The length of the gallbladder is from 5 to 14 centimeters, and the capacity is 30-70 milliliters. In the bladder, the bottom, body and neck are distinguished.

The wall of the gallbladder consists of mucous, muscular, and connective tissue membranes. The mucosa consists of epithelium and various glandular cells. The musculature is made up of smooth muscle fibers. At the neck, the mucous and muscular membranes form a sphincter that prevents the release of bile at the wrong time.

The bladder neck continues into the cystic duct, which then merges with the common hepatic duct to form the common bile duct.
The gallbladder is located on the lower surface of the liver so that the wide end of the gallbladder (bottom) slightly extends beyond the lower edge of the liver.

The function of the gallbladder is to store, concentrate bile and excrete bile as needed.
The liver produces bile and, as unnecessary, bile accumulates in the gallbladder.
Once in the bladder, bile is concentrated by absorption of excess water and trace elements by the epithelium of the bladder.

The secretion of bile occurs after eating. muscle layer bubble is reduced, increasing the pressure in the gallbladder to 200-300 mm. water column. Under the action of pressure, the sphincter relaxes, and bile enters the cystic duct. The bile then enters the common bile duct, which opens into the duodenum.

The role of bile in digestion

Bile in the duodenum creates the necessary conditions for the activity of enzymes found in the pancreatic juice. Bile dissolves fats, which contributes to the further absorption of these fats. Bile is involved in the absorption of vitamins D, E, K, A in the small intestine. Bile also stimulates the secretion of pancreatic juice.

Causes of the development of chronic calculous cholecystitis

The main cause of calculous cholecystitis is the formation of stones.
There are many factors that lead to the formation of gallstones. These factors are divided into: immutable (those that cannot be influenced) and those that can be changed.

Fixed Factors:

• Floor. Most often, women get sick due to the use of contraceptives, childbirth (estrogens, which are elevated during pregnancy, increase the absorption of cholesterol from the intestines and its abundant excretion with bile).
• Age. Persons aged 50 to 60 are more likely to suffer from cholecystitis.
• genetic factors. These include - family predisposition, various congenital anomalies of the gallbladder.
• ethnic factor. The greatest number of cases of cholecystitis is observed in Indians living in the southwestern United States and in the Japanese.

Factors that can be influenced.

• Nutrition . Increased consumption of animal fats and sweets, as well as hunger and rapid weight loss can cause cholecystitis.
• Obesity. The amount of cholesterol in the blood and bile increases, which leads to the formation of stones
• Diseases of the gastrointestinal tract. Crohn's disease, resection (removal) of part of the small intestine
• Medications. Estrogens, contraceptives, diuretics (diuretics) - increase the risk of cholecystitis.
• Hypodynamia (fixed, sedentary lifestyle)
• Decreased tone of the muscles of the gallbladder

How are stones formed?

Stones are from cholesterol, from bile pigments and mixed.
The process of formation of stones from cholesterol can be divided into 2 phases:

First phase- violation in bile of the ratio of cholesterol and solvents (bile acids, phospholipids).
In this phase, there is an increase in the amount of cholesterol and a decrease in the amount of bile acids.

An increase in cholesterol occurs due to a malfunction of various enzymes.
- decreased hydroxylase activity (affects cholesterol lowering)
- decreased activity of acetyl transferase (converts cholesterol to other substances)
- increased breakdown of fats from the fatty layer of the body (increases the amount of cholesterol in the blood).

The decrease in fatty acids occurs for the following reasons.
- Violations of the synthesis of fatty acids in the liver
- Increased excretion of bile acids from the body (impaired absorption of fatty acids in the intestine)
- Violation of intrahepatic circulation

Second phase - bile saturated with cholesterol forms a stasis of bile (stagnation of bile in the bladder), then the process of crystallization occurs - forming crystals of cholesterol monohydrate. These crystals stick together and form stones of various sizes and compositions.
Cholesterol stones may be single or multiple and are usually round or oval in shape. The color of these stones is yellow-green. The sizes of stones vary from 1 millimeter to 3-4 centimeters.

Bile pigment stones are formed due to an increase in the amount of unbound, water-insoluble bilirubin. These stones are composed of various polymers of bilirubin and calcium salts.
Pigment stones are usually small in size up to 10 millimeters. Usually there are several pieces in the bubble. These stones are black or grey.

Most often (80-82% of cases) there are mixed stones. They consist of cholesterol, bilirubin and calcium salts. By the number of stones are always multiple, yellow-brown.

Symptoms of gallstone disease

In 70-80% of cases, chronic calculous cholecystitis develops asymptomatically for several years. Finding stones in the gallbladder in these cases occurs by chance - during an ultrasound done for other diseases.

Symptoms appear only if the stone moves through the cystic canal, which leads to its blockage and inflammation.

Depending on the stage of cholelithiasis, the symptoms presented in the next section of the article are also distinguished.

Clinical stages of gallstone disease

1. Stage of violation physical and chemical properties bile.
At this stage, there are no clinical symptoms. The diagnosis can be made only by the study of bile. Cholesterol "snowflakes" (crystals) are found in bile. Biochemical analysis bile shows an increase in the concentration of cholesterol and a decrease in the amount of bile acids.

2. Latent stage.
At this stage, there are no complaints from the patient. There are already stones in the gallbladder. Diagnosis can be made by ultrasound.

3. The stage of onset of symptoms of the disease.
- Biliary colic is a very severe, paroxysmal and sharp pain that lasts from 2 to 6 hours, sometimes more. Attacks of pain usually appear in the evening or at night.

The pain is in the right hypochondrium and spreads to the right shoulder blade and right cervical region. Pain occurs most often after a rich, fatty meal or after a lot of physical activity.

Products after taking, which may cause pain:

• Cream
• Alcohol
• cakes
• Carbonated drinks

Other symptoms of the disease:

• Increased sweating
• Chills
• Increase in body temperature up to 38 degrees Celsius
• Vomiting bile that does not bring relief

4. Stage of development of complications

At this stage, complications such as:
Acute cholecystitis This disease requires immediate surgical intervention.

Hydrocele of the gallbladder. There is a blockage of the cystic duct by a stone or narrowing to a complete blockage of the duct. The release of bile from the bladder stops. Bile is absorbed from the bladder through the walls, and a serous-mucous secret is secreted into its lumen.
Gradually accumulating, the secret stretches the walls of the gallbladder, sometimes to a huge size.

Perforation or rupture of the gallbladder leads to the development of biliary peritonitis (inflammation of the peritoneum).

hepatic abscess. Limited accumulation of pus in the liver. An abscess forms when a section of the liver is destroyed. Symptoms: high temperature up to 40 degrees, intoxication, liver enlargement.
This disease is treated only surgically.

gallbladder cancer. Chronic calculous cholecystitis greatly increases the risk of cancer.

Diagnosis of gallstone disease

In the case of the above symptoms, you should consult a gastroenterologist or general practitioner.

Conversation with a doctor
The doctor will ask you about your complaints. Reveal the causes of the disease. He will dwell in particular detail on nutrition (after taking, what foods do you feel bad about?). Next, enter all the data into medical card and then start checking.

Inspection
The examination always begins with a visual examination of the patient. If the patient at the time of examination complains of severe pain, then his face will express suffering.

The patient will be in a supine position with the legs bent and brought to the stomach. This position is forced (reduces pain). I would also like to note very important feature, when the patient is turned over to the left side, the pain intensifies.

Palpation (palpation of the abdomen)
With superficial palpation, flatulence (bloating) of the abdomen is determined. It is also defined hypersensitivity in the right hypochondrium. There may be muscle tension in the abdomen.

With deep palpation, an enlarged gallbladder can be determined (normally, the gallbladder is not palpable). Also, with deep palpation, specific symptoms are determined.
1. Murphy's symptom - the appearance of pain during inspiration at the time of probing the right hypochondrium.

2. Ortner's symptom - the appearance of pain in the right hypochondrium, when tapping (percussion) on the right costal arch.

Ultrasound of the liver and gallbladder
On ultrasonography, the presence of stones in the gallbladder is well determined.

Signs of the presence of stones on ultrasound:
1. Presence of solid structures in the gallbladder
2. Mobility (movement) of stones
3. Ultrasonographic hypoechoic (visible as a white gap in the picture) trace below the stone
4. Thickening of the walls of the gallbladder more than 4 millimeters

Abdominal x-ray
Clearly visible stones, which include calcium salts

Cholecystography- study using contrast for better visualization of the gallbladder.

CT scan- performed in the diagnosis of cholecystitis and other diseases

Endoscopic cholangiopancreatography- used to determine the location of a stone in the common bile duct.

The course of chronic calculous cholecystitis
The asymptomatic form of cholecystitis lasts a long time. From the moment of detection of stones in the gallbladder within 5-6 years, only 10-20% of patients begin to develop symptoms (complaints).
The appearance of any complications indicates an unfavorable course of the disease. In addition, many complications are treated only surgically.

Treatment of gallstone disease

Stages of treatment:
1. Prevention of stone movement and related complications
2. Litholytic (stone crushing) therapy
3. Treatment of metabolic (exchange) disorders

In the asymptomatic stage of chronic cholecystitis, the main method of treatment is diet.

Diet for gallstone disease

Meals should be fractional, in small portions 5-6 times a day. The temperature of the food should be - if cold dishes, then not lower than 15 degrees, and if hot dishes, then not higher than 62 degrees Celsius.

Prohibited Products:

Alcoholic drinks
- legumes, in any kind of preparation
- high-fat dairy products (cream, full-fat milk)
- any fried food
- meat from fatty varieties (goose, duck, pork, lamb), lard
- fatty fish, salted, smoked fish, caviar
- any kind of canned goods
- mushrooms
- fresh bread (especially hot bread), croutons
- spices, spices, salinity, pickled products
- coffee, chocolate, cocoa, strong tea
- salty, hard and fatty types of cheese

Cheeses can be eaten, but low-fat

Vegetables should be consumed in boiled, baked form (potatoes, carrots). It is allowed to use finely chopped cabbage, ripe cucumbers, tomatoes. Green onion, parsley to use as an addition to dishes

Meat from non-fat varieties (beef, veal, rabbit), as well as (chicken and turkey without skin). Meat should be consumed boiled or baked. It is also recommended to use minced meat (cutlets)

Vermicelli and pasta allowed

Sweet ripe fruits and berries, as well as various jams and concoctions

Drinks: not strong tea, not sour juices, various mousses, compotes

Butter (30 grams) in dishes

Low-fat types of fish are allowed (perch, cod, pike, bream, perch, hake). It is recommended to use the fish in boiled form, in the form of cutlets, aspic

You can use whole milk. You can also add milk to various cereals.
Not sour cottage cheese, non-sour fat-free yogurts are allowed

Effective treatment of cholecystitis, when symptoms are present, is possible only in a hospital setting!

Drug treatment of biliary colic (pain symptom)

Usually, treatment begins with M-anticholinergics (to reduce spasm) - atropine (0.1% -1 milliliter intramuscularly) or Platifilin - 2% -1 milliliter intramuscularly

If anticholinergics do not help, antispasmodics are used:
Papaverine 2% - 2 milliliters intramuscularly or Drotaverine (Noshpa) 2% - 2 milliliters.

Baralgin 5 milliliters intramuscularly or Pentalgin also 5 milliliters are used as painkillers.
In case of very severe pain, Promedol 2% - 1 ml is used.

Conditions under which the effect of treatment will be maximum:
1. stones containing cholesterol
2. less than 5 millimeters in size
3. the age of the stones is not more than 3 years
4. no obesity
Use drugs such as Ursofalk or Ursosan - 8-13 mg per kilogram of body weight per day.
The course of treatment should be continued for 6 months to 2 years.

Method of direct destruction of stones
The method is based on the direct injection of a strong stone dissolver into the gallbladder.

Extracorporeal shock wave lithotripsy- crushing stones using the energy of shock waves generated outside the human body.

This method is carried out using various devices that produce different kinds waves. For example, waves created by a laser, an electromagnetic installation, an installation that produces ultrasound.

Any of the devices is installed in the projection of the gallbladder, then waves from various sources act on the stones and they are crushed to small crystals.

Then these crystals are freely excreted along with bile into the duodenum.
This method is used when the stones are no larger than 1 centimeter and when the gallbladder is still functioning.
In other cases, in the presence of symptoms of cholecystitis, it is recommended surgical operation to remove the gallbladder.

Surgical removal of the gallbladder

There are two main types of cholecystectomy (removal of the gallbladder)
1. Standard cholecystectomy
2. Laparoscopic cholecystectomy

The first type has been used for a long time. Standard method based on abdominal surgery (with an open abdominal cavity). Recently, it has been used less and less due to frequent postoperative complications.

The laparoscopic method is based on the use of a laparoscope apparatus. This apparatus consists of several parts:
- high magnification video cameras
- different kinds of tools
Advantages of the 2nd method over the first:
1. Laparoscopic surgery does not require large incisions. The incisions are made in several places and are very small.
2. The seams are cosmetic, so they are practically invisible
3. Health is restored 3 times faster
4. The number of complications is ten times less

Prevention of gallstone disease

Primary prevention– is to prevent the formation of stones. The main method of prevention is sports, diet, exclusion of alcohol, exclusion of smoking, weight loss in case of overweight.

Secondary prevention is to prevent complications. The main method of prevention is effective treatment chronic cholecystitis described above.

Why is gallstone disease dangerous?

Gallstone disease or calculous cholecystitis is the formation of stones in the gallbladder. Often this causes a pronounced inflammatory process and leads to the appearance of serious symptoms. The disease first manifests itself severe pain, violation of the outflow of bile from the gallbladder, digestive disorders. Treatment of gallstone disease is usually referred to as a surgical profile. This is due to the fact that the inflammatory process caused by the movement of stones is serious threat for the health and life of patients. That is why the problem is usually solved in the fastest way - removal of the gallbladder along with stones.

Gallstone disease is dangerous, first of all, with the following complications:

• Gallbladder perforation. A perforation is a rupture of the gallbladder. It can be caused by the movement of stones or too much contraction ( spasm) smooth muscle of the organ. In this case, the contents of the organ enter the abdominal cavity. Even if there was no pus inside, the bile itself can cause serious irritation and inflammation of the peritoneum. The inflammatory process extends to intestinal loops and other neighboring organs. Most often, in the cavity of the gallbladder there are opportunistic microbes. In the abdominal cavity, they multiply rapidly, realizing their pathogenic potential and leading to the development of peritonitis.
• Empyema of the gallbladder. An empyema is a collection of pus in a natural body cavity. With calculous cholecystitis, the stone often gets stuck at the level of the bladder neck. At first, this leads to dropsy - the accumulation of mucous secretion in the cavity of the organ. The pressure inside increases, the walls stretch, but may contract spastically. This leads to severe pain - biliary colic. If such a clogged gallbladder becomes infected, the mucus turns into pus and empyema occurs. Usually pathogens are bacteria from the genera Escherichia, Klebsiella, Streptococcus, Proteus, Pseudomonas, less often Clostridium and some other microorganisms. They can be ingested through the bloodstream or travel up the bile duct from the intestines. With the accumulation of pus, the patient's condition worsens greatly. The temperature rises, headaches intensify ( due to absorption of waste products into the blood). Without urgent surgery, the gallbladder ruptures, its contents enter the abdominal cavity, causing purulent peritonitis. At this stage ( after the break) the disease often ends in the death of the patient, despite the efforts of doctors.
• Reactive hepatitis. The inflammatory process from the gallbladder can spread to the liver, causing inflammation. The liver also suffers from a deterioration in local blood flow. Typically, this problem unlike viral hepatitis) passes quite quickly after removal of the gallbladder - the main center of inflammation.
• Acute cholangitis . This complication involves blockage and inflammation of the bile duct. In this case, the outflow of bile is disturbed by a stone stuck in the duct. Since the bile ducts are connected to the ducts of the pancreas, pancreatitis can also develop in parallel. Acute cholangitis occurs with severe fever, chills, jaundice, severe pain in the right hypochondrium.
• Acute pancreatitis. Usually occurs due to lack of bile ( that is not released from the clogged bladder) or blockage of the common duct. Pancreatic juice contains a large amount of strong digestive enzymes. Their stagnation can cause necrosis ( death) of the gland itself. Such a form acute pancreatitis poses a serious threat to the life of the patient.
• Biliary fistulas. If gallstones do not cause severe pain, the patient may ignore them for a long time. However, the inflammatory process in the organ wall ( directly around the stone) is still evolving. The destruction of the wall and its “soldering” with neighboring anatomical structures gradually occur. Over time, a fistula may form, connecting the gallbladder with other hollow organs. These organs can be the duodenum ( more often), stomach, small intestine, large intestine. There are also options for fistulas between the bile ducts and these organs. If the stones themselves do not bother the patient, then fistulas can cause air accumulation in the gallbladder, violations of the outflow of bile ( and intolerance to fatty foods), jaundice, vomiting of bile.
• Paravesical abscess. This complication is characterized by the accumulation of pus near the gallbladder. Usually, an abscess is delimited from the rest of the abdominal cavity by adhesions that have arisen against the background of an inflammatory process. From above, the abscess is limited to the lower edge of the liver. The complication is dangerous by the spread of infection with the development of peritonitis, impaired liver function.
• Scar strictures. Strictures are places of narrowing in the bile duct that prevent the normal flow of bile. In cholelithiasis, this complication may occur as a result of inflammation ( the body responds with excessive formation of connective tissue - scars) or as a consequence of an intervention to remove stones. Either way, strictures can persist even after recovery and seriously affect the body's ability to digest and absorb fatty foods. In addition, if stones are removed without removing the gallbladder, strictures can cause bile stasis. In general, people with these duct narrowings are more likely to relapse ( repeated inflammation of the gallbladder).
• Secondary biliary cirrhosis. This complication can occur if gallstones prevent the flow of bile for a long time. The fact is that bile enters the gallbladder from the liver. Its overflow causes stagnation of bile in the ducts in the liver itself. It can eventually lead to the death of hepatocytes ( normal liver cells) and their substitution connective tissue, which does not perform the necessary functions. This phenomenon is called cirrhosis. The result is serious violations of blood clotting, impaired absorption of fat-soluble vitamins ( A, D, E, K), accumulation of fluid in the abdominal cavity ( ascites), severe intoxication ( poisoning) organism.

Thus, gallstone disease requires a very serious attitude. In the absence of timely diagnosis and treatment, it can significantly harm the health of the patient, and sometimes endanger his life. To increase the chances of a successful recovery, the first symptoms of calculous cholecystitis should not be ignored. Seeing a doctor early can often help detect stones when they have not yet reached a significant size. In this case, the likelihood of complications is lower and it may not be necessary to resort to surgical treatment with the removal of the gallbladder. However, if necessary, agree to the operation is still necessary. Only the attending physician can adequately assess the situation and choose the most effective and safe method of treatment.

Can calculous cholecystitis be cured without surgery?

Currently, surgical intervention remains the most effective and justified way to treat calculous cholecystitis. With the formation of stones in the gallbladder, as a rule, an inflammatory process develops, which not only disrupts the functioning of the organ, but also poses a threat to the body as a whole. Surgery to remove the gallbladder along with stones is the most appropriate treatment. In the absence of complications, the risk to the patient remains minimal. The organ itself is usually removed endoscopically ( without dissection of the anterior abdominal wall, through small holes).

The main advantages of surgical treatment of calculous cholecystitis are:

• Radical solution to the problem. Removal of the gallbladder guarantees the cessation of pain ( biliary colic), since colic appears due to contractions of the muscles of this organ. In addition, there is no risk of recurrence ( repeated exacerbations) gallstone disease. Bile can no longer accumulate in the bladder, stagnate and form stones. It will go directly from the liver to the duodenum.
• Patient safety. Today, endoscopic removal of the gallbladder ( cholecystectomy) is a routine operation. The risk of complications during surgery is minimal. Subject to all the rules of asepsis and antisepsis, postoperative complications are also unlikely. The patient recovers quickly and can be discharged ( in consultation with the attending physician) a few days after the operation. After a few months, he can lead the most normal life, apart from a special diet.
• Ability to treat complications. Many patients go to the doctor too late, when complications of calculous cholecystitis begin to appear. Then surgical treatment is simply necessary to remove pus, examine neighboring organs, and adequately assess the risk to life.

However, the operation also has its downsides. Many patients are simply afraid of anesthesia and surgery. In addition, any operation is stressful. There is a risk ( albeit minimal) postoperative complications, due to which the patient has to stay in the hospital for several weeks. The main disadvantage of cholecystectomy is the removal of the organ itself. Bile after this operation no longer accumulates in the liver. It continuously enters the duodenum in a small amount. The body loses the ability to regulate the flow of bile in certain portions. Because of this, you have to follow a diet without fatty foods for the rest of your life ( not enough bile to emulsify fats).

Nowadays, there are several ways of non-surgical treatment of calculous cholecystitis. At the same time, it is not about symptomatic treatment (muscle spasm relief, pain relief), namely, getting rid of stones inside the gallbladder. The main advantage of these methods is the preservation of the organ itself. With a successful result, the gallbladder is freed from stones and continues to perform its functions of accumulating and dosed bile secretion.

There are three main methods of non-surgical treatment of calculous cholecystitis:

• Medical dissolution of stones. This method is perhaps the safest for the patient. long time the patient should take drugs based on ursodeoxycholic acid. It promotes the dissolution of stones containing bile acids. The problem is that even to dissolve small stones, it is necessary to take the medicine regularly for several months. If we are talking about larger stones, the course can be delayed for 1 - 2 years. However, there is no guarantee that the stones will dissolve completely. Depending on the individual characteristics of metabolism, they may contain impurities that will not dissolve. As a result, the stones will decrease in size, the symptoms of the disease will disappear. However, this effect will be temporary.
• Ultrasonic crushing of stones. Today, crushing stones with the help of ultrasonic waves is a fairly common practice. The procedure is safe for the patient, easy to perform. The problem is that the stones are crushed into sharp fragments, which still cannot leave the gallbladder without injuring it. In addition, the problem of stagnation of bile is not solved radically, and after a while ( usually several years) stones can form again.
• Laser stone removal. It is used quite rarely due to the high cost and relatively low efficiency. Stones are also subjected to a kind of crushing and fall apart. However, even these parts can injure the mucous membrane of the organ. In addition, there is a high risk of recurrence ( re-formation of stones). Then the procedure will have to be repeated.

Thus, non-surgical treatment of calculous cholecystitis exists. However, it is used mainly for small stones, as well as for the treatment of patients who are dangerous to operate ( due to comorbidities). In addition, none of the non-surgical methods of stone removal is recommended in the acute course of the process. Associated inflammation requires precisely surgical treatment areas with examination of neighboring organs. This will avoid complications. If intense inflammation has already begun, crushing the stones alone will not solve the problem. Therefore, all non-surgical methods are used mainly for the treatment of patients with stone bearing ( chronic course of the disease).

When is surgery needed for gallstone disease?

Gallstone disease or calculous cholecystitis in the vast majority of cases at a certain stage of the disease require surgical treatment. This is due to the fact that the stones that form in the gallbladder are usually found only with a pronounced inflammatory process. This process is called acute cholecystitis. The patient is concerned about severe pain in the right hypochondrium ( colic), which are exacerbated after eating. The temperature may also rise. IN acute stage there is a possibility of serious complications, so they are trying to solve the problem radically and quickly. Cholecystectomy is such a solution - an operation to remove the gallbladder.

Cholecystectomy involves the complete removal of the bladder along with the stones it contains. With an uncomplicated course of the disease, it guarantees a solution to the problem, since the bile formed in the liver will no longer accumulate and stagnate. The pigments simply won't be able to form stones again.

There are many indications for cholecystectomy. They are divided into absolute and relative. Absolute indications are those without which serious complications can develop. Thus, if the operation is not performed when there are absolute indications, the life of the patient will be endangered. In this regard, doctors in such situations always try to convince the patient of the need for surgical intervention. There are no other treatments available or they will take too long and increase the risk of complications.

Absolute indications for cholecystectomy in cholelithiasis are:

• A large number of stones. If gallstones ( regardless of their number and size) occupy more than 33% of the organ volume, cholecystectomy should be performed. It is almost impossible to crush or dissolve such a large number of stones. At the same time, the organ does not work, since the walls are very stretched, they contract poorly, stones periodically clog the neck area and interfere with the outflow of bile.
• Frequent colic. Attacks of pain in cholelithiasis can be very intense. Remove them with antispasmodic drugs. However, frequent colic suggests that drug treatment does not bring success. In this case, it is better to resort to the removal of the gallbladder, regardless of how many stones are in it and what size they are.
• Stones in the bile duct. When the bile ducts are blocked by a stone from the gallbladder, the patient's condition worsens greatly. The outflow of bile stops completely, the pain intensifies, develops obstructive jaundice (due to the free fraction of bilirubin).
• Biliary pancreatitis. Pancreatitis is an inflammation of the pancreas. This organ has a common excretory duct with the gallbladder. In some cases, with calculous cholecystitis, the outflow of pancreatic juice is disturbed. The destruction of tissues in pancreatitis endangers the life of the patient, so the problem must be urgently solved by surgical intervention.

Unlike absolute indications, relative indications suggest that there are other treatments besides surgery. For example, in the chronic course of cholelithiasis, stones may not bother the patient for a long time. He does not have colic or jaundice, as happens in the acute course of the disease. However, doctors believe that in the future the disease may worsen. The patient will be offered an elective operation, but this will be relative indication, since at the time of the operation he has practically no complaints and no inflammatory process.

Separately, it should be noted the surgical treatment of complications of acute cholecystitis. In this case, we are talking about the spread of the inflammatory process. Problems with the gallbladder are reflected in the work of neighboring organs. In such situations, the operation will include not only the removal of the gallbladder with stones, but also the solution of the resulting problems.

Surgery without fail, it may also be necessary for the following complications of gallstone disease:

• Peritonitis. Peritonitis is an inflammation of the peritoneum, the membrane that covers most of the abdominal organs. This complication occurs when the inflammatory process spreads from the gallbladder or perforation ( gap) of this organ. Bile, and often a large number of microbes, enters the abdominal cavity, where intense inflammation begins. The operation is necessary not only to remove the gallbladder, but also to thoroughly disinfect the abdominal cavity as a whole. It is impossible to postpone surgical intervention, since peritonitis is fraught with the death of the patient.
• Bile duct strictures. Strictures are called narrowing of the canal. Such narrowing can be formed due to the inflammatory process. They obstruct the outflow of bile and cause stagnation in the liver, although the gallbladder itself can be removed. Surgery is needed to remove strictures. As a rule, the narrowed area is expanded or a bypass is made for bile from the liver to the duodenum. Apart from surgery, there is no effective solution to this problem.
• accumulation of pus. Purulent complications of gallstone disease occur when an infection enters the gallbladder. If pus accumulates inside the organ, gradually filling it, such a complication is called empyema. If pus accumulates near the gallbladder, but does not spread through the abdominal cavity, they speak of a paravesical abscess. The patient's condition with these complications is greatly deteriorating. The risk of spreading the infection is high. The operation includes removal of the gallbladder, emptying the purulent cavity and thoroughly disinfecting it to prevent peritonitis.
• Biliary fistulas. Gallbladder fistulas are pathological openings between the gallbladder ( less commonly by biliary tract) and neighboring hollow organs. Fistulas may not cause acute symptoms, but they disrupt the natural process of outflow of bile, digestion, and also predispose to other diseases. The operation is performed to close pathological openings.

In addition to the stage of the disease, its form and the presence of complications, comorbidities and age play an important role in the choice of treatment. In some cases, patients are contraindicated in drug treatment ( drug intolerance). Then surgical treatment will be a reasonable solution to the problem. Elderly patients with chronic diseases ( heart failure, kidney failure, etc.) may simply not undergo surgery, therefore, in such cases, surgical treatment, on the contrary, is tried to be avoided. Thus, the tactics of treating gallstone disease can vary in different situations. It is only the attending physician who can determine unambiguously whether the operation is necessary for the patient after a full examination.

How to treat gallstone disease with folk remedies?

In the treatment of gallstone disease folk remedies ineffective. The fact is that with this disease, stones begin to form in the gallbladder ( usually crystals containing bilirubin). It is almost impossible to dissolve these stones with folk methods. For their splitting or crushing, respectively, powerful pharmacological preparations or ultrasonic waves are used. However, folk remedies play a role in the treatment of patients with gallstone disease.

Possible effects of medicinal plants in gallstone disease are:

• Relaxation smooth muscles . Some medicinal plants relax the muscular sphincter of the gallbladder and the smooth muscles of its walls. This relieves pain attacks usually caused by spasm).
• Decreased bilirubin level. Elevated levels of bilirubin in bile especially if it's been stuck for a long time) may contribute to the formation of stones.
• outflow of bile. Due to the relaxation of the sphincter of the gallbladder, the outflow of bile occurs. It does not stagnate, and crystals and stones do not have time to form in the bubble.

Thus, the effect of the use of folk remedies will be predominantly preventive. Patients with abnormal liver function or other factors predisposing to gallstone disease will benefit from periodic treatment. This will slow down the formation of stones and prevent the problem before it occurs.

For the prevention of gallstone disease, you can use the following folk remedies:

• radish juice. Black radish juice is diluted with honey in equal proportions. You can also cut a cavity in a radish and pour honey into it for 10-15 hours. After that, a mixture of juice and honey is consumed 1 tablespoon 1-2 times a day.
• barberry leaves. Green leaves of barberry are thoroughly washed with running water and filled with alcohol. For 20 g of crushed leaves, 100 ml of alcohol are needed. Infusion lasts 5 - 7 hours. After that, the tincture is drunk 1 teaspoon 3-4 times a day. The course lasts 1 - 2 months. It can be repeated after six months.
• Rowan tincture. 30 g of rowan berries pour 500 ml of boiling water. Insist 1 - 2 hours ( while the temperature drops to room temperature). Then the infusion is taken half a cup 2-3 times a day.
• Mummy. Shilajit can be taken both for the prevention of stone formation, and for cholelithiasis ( if the diameter of the stones does not exceed 5 - 7 mm). It is diluted in a ratio of 1 to 1000 ( 1 g mummy per 1 liter of warm water). Before meals, drink 1 glass of solution, three times a day. This tool can be used no more than 8 - 10 days in a row, after which you need to take a break of 5 - 7 days.
• Mint with celandine. Equal proportions of the dry leaves of these herbs are consumed as an infusion. For 2 tablespoons of the mixture, 1 liter of boiling water is needed. Infusion lasts 4 - 5 hours. After that, the infusion is consumed 1 glass per day. Sediment ( grass) is filtered before use. It is not recommended to store the infusion for more than 3 - 4 days.
• Highlander snake. To prepare a decoction, you need 2 tablespoons of dry chopped rhizome, pour 1 liter of boiling water and cook for 10-15 minutes over low heat. 10 minutes after turning off the fire, the broth is decanted and allowed to cool ( usually 3 - 4 hours). The decoction is taken 2 tablespoons half an hour before meals twice a day.

A common method of preventing gallstone disease is blind probing which can be done at home. This procedure is also used in medical institutions. Its purpose is to empty the gallbladder and prevent bile stasis. People with gallstones discovered during ultrasound examination ) Blind probing is contraindicated, as this will lead to the entry of a stone into the bile duct and may seriously impair general state.

To prevent stagnation of bile using blind probing, pharmacological preparations or some natural mineral water. Water or medicine should be drunk on an empty stomach, after which the patient lies on his right side, placing it under the right hypochondrium ( on the area of ​​the liver and gallbladder) warm heating pad. You need to lie down for 1 - 2 hours. During this time, the sphincter will relax, the bile duct will expand, and the bile will gradually come out into the intestines. The success of the procedure is indicated by dark stools with bad smell In a few hours. It is advisable to consult with your doctor about the method of blind probing and its expediency in each specific case. After the procedure, you need to follow a low-fat diet for several days.

Thus, folk remedies can successfully prevent the formation of gallstones. At the same time, the regularity of treatment courses is important. It is also advisable to undergo preventive examinations with a doctor. This will help to detect small stones ( using ultrasound) if folk methods won't help. After the formation of stones, the effectiveness of the funds traditional medicine greatly reduced.

What are the first signs of gallstone disease?

Gallstone disease can proceed secretly for a long time, without showing itself in any way. During this period, stagnation of bile in the gallbladder and the gradual formation of stones occur in the patient's body. Stones are formed from pigments found in bile ( bilirubin and others), and resemble crystals. The longer the stagnation of bile, the faster these crystals grow. At a certain stage, they begin to injure the inner shell of the organ, interfere with the normal contraction of its walls and prevent the normal outflow of bile. From this point on, the patient begins to experience certain problems.

Usually, gallstone disease manifests itself for the first time as follows:

• Heaviness in the abdomen. A subjective feeling of heaviness in the abdomen is one of the first manifestations of the disease. Most patients complain about it when they see a doctor. The severity is localized in the epigastrium ( under the pit of the stomach, in the upper abdomen) or in the right hypochondrium. It can appear spontaneously, after physical exertion, but most often - after eating. This feeling is due to stagnation of bile and an increase in the gallbladder.
• Pain after eating. Sometimes the first symptom of the disease is pain in the right hypochondrium. In rare cases, it is biliary colic. It is a severe, sometimes unbearable pain that can radiate to right shoulder or spatula. However, often the first attacks of pain are less intense. It is rather a feeling of heaviness and discomfort, which, when moving, can turn into stabbing or bursting pain. Discomfort occurs an hour and a half after eating. Especially often pain attacks seen after taking a large number fatty foods or alcohol.
• Nausea. Nausea, heartburn, and sometimes vomiting can also be the first manifestations of the disease. They also usually appear after eating. The connection of many symptoms with food intake is explained by the fact that the gallbladder normally releases a certain portion of bile. It is needed for emulsification ( a kind of dissolution and assimilation) fats and activation of certain digestive enzymes. In patients with gallstones, bile is not excreted, food is digested worse. Therefore, nausea occurs. Backward reflux of food into the stomach leads to belching, heartburn, gas accumulation, and sometimes vomiting.
• Stool changes. As mentioned above, bile is necessary for the normal absorption of fatty foods. With uncontrolled secretion of bile, prolonged constipation or diarrhea may occur. Sometimes they appear even before other symptoms typical of cholecystitis. For more late stages stool may be discolored. This means that the stones clogged the ducts, and bile is practically not excreted from the gallbladder.
• Jaundice. Yellowing of the skin and sclera of the eyes is rarely the first symptom of gallstone disease. It usually occurs after digestive problems and pain. Jaundice is caused by stagnation of bile not only at the level of the gallbladder, but also in the ducts inside the liver ( where bile is produced). Due to a violation of the liver, a substance called bilirubin accumulates in the blood, which is normally excreted with bile. Bilirubin enters the skin, and its excess gives it a characteristic yellowish tint.

From the moment the formation of stones begins to the first signs of the disease, it usually takes quite a long time. According to some studies, the asymptomatic period lasts an average of 10 to 12 years. If there is a predisposition to the formation of stones, it can be reduced to several years. In some patients, stones form slowly and grow throughout life, but do not reach the stage of clinical manifestations. Such stones are sometimes found at autopsy after the death of the patient for other reasons.

It is usually difficult to make a correct diagnosis based on the first symptoms and manifestations of gallstone disease. Nausea, vomiting and indigestion can also occur with disorders in other organs of the digestive system. To clarify the diagnosis, an ultrasound is prescribed ( ultrasonography) of the abdominal cavity. It allows you to detect a characteristic increase in the gallbladder, as well as the presence of stones in its cavity.

Can calculous cholecystitis be treated at home?

Where the treatment of calculous cholecystitis will take place depends entirely on the condition of the patient. Patients are usually admitted to hospital with sharp forms diseases, but there may be other indications. At home, gallstone disease can be treated with medication if it occurs in a chronic form. In other words, a patient with gallstones does not need urgent hospitalization unless they have acute pain, temperature and other signs of inflammation. However, sooner or later the question of surgical elimination of the problem arises. Then, of course, you need to go to the hospital.


In general, it is recommended to hospitalize the patient in the following cases:

• Acute forms of the disease. In the acute course of calculous cholecystitis, a serious inflammatory process develops. Without proper patient care, the course of the disease can become very complicated. In particular, we are talking about the accumulation of pus, the formation of an abscess or the development of peritonitis ( inflammation of the peritoneum). In the acute course of the disease, hospitalization should not be postponed, since the above-mentioned complications can develop within 1 to 2 days after the first symptoms.
• The first signs of the disease. It is recommended that patients who present with symptoms and signs of calculous cholecystitis be admitted to the hospital for the first time. There they will do all the necessary research within a few days. They will help to figure out what kind of disease the patient has, what his condition is, whether there is a question of urgent surgical intervention.
• Accompanying illnesses. Cholecystitis can develop in parallel with other health problems. For example, in patients with chronic heart failure, diabetes mellitus or other chronic diseases, it can cause an exacerbation and a serious deterioration in the condition. To carefully monitor the course of the disease, it is recommended to put the patient in the hospital. There, if necessary, he will be quickly provided with any assistance.
• Patients with social problems . Hospitalization is recommended for all patients who cannot be provided with urgent help at home. For example, a patient with chronic cholelithiasis lives very far from the hospital. In the event of an exacerbation, it will not be possible for him to quickly provide qualified assistance ( usually about surgery.). During transportation, serious complications may develop. A similar situation arises with older people who have no one to look after at home. In these cases, it makes sense to operate even a non-acute process. This will prevent an exacerbation of the disease in the future.
• Pregnant women. Calculous cholecystitis in pregnancy carries a higher risk for both mother and fetus. In order to have time to provide assistance, it is recommended to hospitalize the patient.
• Patient's wish. Any patient with chronic cholelithiasis can own will go to the hospital for surgical removal of gallstones. This is much more profitable than operating on an acute process. Firstly, the risk of complications during surgery and in the postoperative period is reduced. Secondly, the patient himself chooses the time ( vacation, scheduled sick leave, etc.). Thirdly, he deliberately excludes the risk of repeated complications of the disease in the future. The prognosis for such elective operations is much better. Doctors have more time to carefully examine the patient before treatment.

Thus, hospitalization at a certain stage of the disease is necessary for almost all patients with cholelithiasis. Not everyone has it associated with the operation. Sometimes it is a preventive course of treatment or diagnostic procedures carried out to monitor the course of the disease. The duration of hospitalization depends on its goals. Examination of a patient with newly discovered gallstones usually takes 1 to 2 days. Prophylactic drug treatment or surgery depends on the presence of complications. Hospitalization can last from several days to several weeks.

At home, the disease can be treated under the following conditions:

• chronic course of gallstone disease ( no acute symptoms);
• final diagnosis;
• strict adherence to the instructions of a specialist ( regarding prevention and treatment);
• the need for long-term medical treatment ( for example, non-surgical dissolution of stones can take 6 to 18 months);
• the possibility of caring for the patient at home.

Thus, the possibility of treatment at home depends on many different factors. The expediency of hospitalization in each case is determined by the attending physician.

Is it possible to play sports with gallstone disease?

Cholelithiasis or calculous cholecystitis is enough serious illness which must be taken very seriously. The formation of gallstones may not cause noticeable symptoms at first. Therefore, some patients, even after accidentally discovering a problem ( during preventive ultrasound examination) continue to lead a normal life, neglecting the regimen prescribed by the doctor. In some cases, this can lead to accelerated progression of the disease and deterioration of the patient's condition.

One of important conditions preventive regimen is to limit physical activity. This is necessary after the discovery of stones, during the acute stage of the disease, as well as during treatment. At the same time, we are talking not only about professional athletes, whose training requires all the strength, but also about everyday physical activity. At each stage of the disease, they can affect the development of events in different ways.

The main reasons for limiting physical activity are:

• Accelerated production of bilirubin. Bilirubin is a natural metabolic product ( metabolism). This substance is formed during the breakdown of hemoglobin - the main component of red blood cells. The more physical activity a person performs, the faster red blood cells break down and the more hemoglobin enters the blood. As a result, the level of bilirubin also rises. This is especially dangerous for people who have bile stasis or a predisposition to the formation of stones. The gallbladder accumulates bile with a high concentration of bilirubin, which gradually crystallizes and forms stones. Thus, people who already have cholestasis ( bile stasis), but the stones have not yet formed, heavy physical exercise not recommended for preventive purposes.
• Movement of stones. If the stones have already formed, then serious loads can lead to their movement. Most often, stones are located in the area of ​​the bottom of the gallbladder. There they can cause a moderate inflammatory process, but do not interfere with the outflow of bile. As a result of physical activity, intra-abdominal pressure rises. This is reflected to some extent in the gallbladder. It is compressed, and the stones can set in motion, moving to the neck of the organ. There, the stone gets stuck at the level of the sphincter or in the bile duct. As a result, a serious inflammatory process develops, and the disease acquires an acute course.
• Progression of symptoms. If the patient already has digestive disorders, pain in the right hypochondrium or other symptoms of gallstone disease, then physical activity can provoke an exacerbation. For example, pain due to inflammation can turn into biliary colic. If the symptoms are caused by the movement of stones and blockage of the bile duct, then they will not disappear after the cessation of exercise. Thus, there is a chance that even a single exercise ( running, jumping, lifting weights, etc.) can lead to urgent hospitalization and surgery. However, we are talking about people who already suffer from a chronic form of the disease, but do not comply with the regimen prescribed by the doctor.
• Risk of complications of gallstone disease. Calculous cholecystitis is almost always accompanied by an inflammatory process. At first, it is caused by mechanical trauma to the mucous membrane. However, many patients also develop an infectious process. As a result, pus may form and accumulate in the bladder cavity. If, under such conditions, intra-abdominal pressure rises sharply or the patient makes a sharp bad turn, the swollen gallbladder may burst. The infection will spread throughout the abdominal cavity, and peritonitis will begin. Thus, sports and physical activity in general can contribute to the development of serious complications.
• Risk of postoperative complications. Acute cholecystitis often needs to be treated surgically. There are two main types of operations - open, when an incision is made in the abdominal wall, and endoscopic, when removal occurs through small openings. In both cases, after the operation, any physical activity is contraindicated for some time. With open surgery, healing takes longer, more sutures are placed, and the risk of divergence is higher. With endoscopic removal of the gallbladder, the patient recovers faster. As a rule, full-fledged loads are allowed to be given only 4-6 months after the operation, provided that the doctor does not see other contraindications for this.

Thus, sports are most often contraindicated in patients with cholecystitis. However, moderate exercise is necessary in certain cases. For example, to prevent the formation of stones, you should do gymnastics and take short walks at a moderate pace. This promotes normal contractions of the gallbladder and prevents bile from stagnating. As a result, even if the patient has a predisposition to the formation of stones, this process slows down.

• daily walks for 30 - 60 minutes at an average pace;
• gymnastic exercises without sudden movements with limited load on the abdominal press;
• swimming ( not for speed) without diving to great depths.

These types of loads are used to prevent the formation of stones, as well as restore muscle tone after surgery ( then they start after 1 - 2 months). When it comes to professional sports with heavy loads ( weightlifting, sprinting, jumping, etc.), they are contraindicated in all patients with gallstone disease. After the operation, full-fledged training should begin no earlier than after 4-6 months, when the incision sites are well healed and strong connective tissue is formed.

Is pregnancy dangerous with gallstone disease?

Gallstone disease in pregnant women is a fairly common occurrence in medical practice. On the one hand, this disease is typical for older women. However, it is during pregnancy that there are quite a few prerequisites for the appearance of stones in the gallbladder. Most often it occurs in patients with a hereditary predisposition or with chronic liver diseases. According to statistics, an exacerbation of gallstone disease usually occurs in the third trimester of pregnancy.

The prevalence of this problem during pregnancy is explained as follows:

• Metabolic changes. As a result of hormonal changes, the metabolism in the body also changes. This can lead to accelerated stone formation.
• Motility changes. Normally, the gallbladder stores bile and contracts, releasing it in small portions. During pregnancy, the rhythm and strength of its contractions are disturbed ( dyskinesia). As a result, bile stasis can develop, which contributes to the formation of stones.
• Increased intra-abdominal pressure. If a woman already had small gallstones, then the growth of the fetus can lead to their movement. This is especially true in the third trimester, when the growing fetus pushes up the stomach, colon, and gallbladder. These organs are compressed. As a result, the stones located near the bottom of the bubble ( at the top of it), can enter the bile duct and block it. This will lead to the development of acute cholecystitis.
• Sedentary lifestyle. Pregnant women often neglect walks or elementary exercise, which contribute, among other things, to the normal functioning of the gallbladder. This leads to stagnation of bile and acceleration of the formation of stones.
• Diet change. Changing food preferences can affect the composition of the microflora in the intestine, worsen the motility of the bile ducts. If at the same time the woman had a latent ( asymptomatic) form of gallstone disease, the risk of exacerbation greatly increases.

Unlike other patients with this disease, pregnant women are at much greater risk. Any complication of the disease is fraught with problems not only for the mother's body, but also for the developing fetus. Therefore, all cases of exacerbation of cholecystitis during pregnancy are regarded as urgent. Patients are hospitalized for confirmation of the diagnosis and a thorough assessment of the general condition.

Exacerbation of gallstone disease during pregnancy is especially dangerous for the following reasons:

• high risk of rupture due to increased intra-abdominal pressure;
• high risk of infectious complications ( including purulent processes) due to weakened immunity;
• fetal intoxication due to the inflammatory process;
• malnutrition of the fetus due to poor digestion ( food is absorbed worse, as bile does not enter the duodenum);
• limited opportunities treatment ( not all drugs and treatments that are commonly used for gallstone disease are suitable for pregnant women).

With timely access to a doctor, serious complications can usually be avoided. The work of the gallbladder and its diseases do not directly affect the reproductive system. Patients are usually hospitalized, and if necessary, a cholecystectomy is performed - removal of the gallbladder. Preference is given to minimally invasive endoscopic) methods. There are peculiarities in the technique of surgical intervention and methods of anesthesia.

In the absence of complications of gallstone disease, the prognosis for the mother and child remains favorable. If the patient turned to a specialist too late, and the inflammatory process began to spread in the abdominal cavity, the question of extracting the fetus by caesarean section may be raised. At the same time, the prognosis worsens somewhat, since we are talking about a technically complex surgical intervention. It is necessary to remove the gallbladder, remove the fetus, carefully examine the abdominal cavity to prevent the development of peritonitis.

What are the types of calculous cholecystitis?

Calculous cholecystitis is not the same for all patients. This disease is caused by the formation of stones in the gallbladder, due to which an inflammatory process develops. Depending on how exactly this process will proceed, as well as on the stage of the disease, there are several types of calculous cholecystitis. Each of them has not only its own characteristics of the course and manifestations, but also requires a special approach to treatment.

From the point of view of the main manifestations of the disease(clinical form)There are the following types of calculous cholecystitis:

• stone carrier. This form is latent. The disease does not show up. The patient feels great, does not experience any pain in the right hypochondrium, or problems with digestion. However, the stones have already formed. They gradually increase in number and size. This will happen until the accumulated stones begin to disrupt the functioning of the organ. Then the disease will begin to manifest. Stone carriers can be detected during a preventive ultrasound examination. It is more difficult to see stones on a plain x-ray of the abdomen. When a stone carrier is found, there is no question of an emergency operation. Doctors have time to try other treatments.
• Dyspeptic form. In this form, the disease is manifested by a variety of digestive disorders. It can be difficult to suspect cholecystitis at first, since there are no typical pains in the right hypochondrium. Patients are concerned about heaviness in the stomach, in the epigastrium. Often after a large meal especially fatty foods and alcohol) there is an eructation with a taste of bitterness in the mouth. This is due to violations of bile secretion. Also, patients may have problems with the stool. In this case ultrasound examination help confirm the correct diagnosis.
• biliary colic. In fact, biliary colic is not a form of gallstone disease. This is a common specific symptom. The problem is that in the acute stage of the disease, severe pain attacks often appear ( every day and sometimes more). The effect of antispasmodic drugs is temporary. Gallbladder colic is caused by painful contraction of smooth muscles in the walls of the gallbladder. They are usually observed with large stones, overstretching of the organ, ingress of a stone into the bile duct.
• Chronic recurrent cholecystitis. The recurrent form of the disease is characterized by repeated bouts of cholecystitis. The attack is manifested by severe pain, colic, fever, characteristic changes in blood tests ( increases the level of leukocytes and the erythrocyte sedimentation rate - ESR). Relapse occurs when unsuccessful attempts are made. conservative treatment. Medicines temporarily bring down the inflammatory process, and some medical procedures can temporarily improve the outflow of bile. But as long as there are stones in the gallbladder cavity, the risk of recurrence remains high. Surgery ( cholecystectomy - removal of the gallbladder) solves this problem once and for all.
• Chronic residual cholecystitis. This form is not recognized by all experts. It is sometimes spoken of in cases where an attack of acute cholecystitis has passed. The patient's temperature decreased, and the general condition returned to normal. However, the symptoms remained moderate pain in the right hypochondrium, which is aggravated by palpation ( palpation of this area). Thus, we are not talking about a complete recovery, but about the transition to a special form - residual ( residual) cholecystitis. As a rule, over time, the pain disappears or the disease worsens again, turning into acute cholecystitis.
• angina pectoris form. Is rare clinical form calculous cholecystitis. Its difference from others is that the pain from the right hypochondrium spreads to the region of the heart and provokes an attack of angina pectoris. Heart rhythm disturbances and other symptoms of the cardiovascular system may also be observed. This form is more common in patients with chronic ischemic heart disease. Biliary colic in this case plays the role of a kind of "trigger". The problem is that due to an attack of angina pectoris, doctors often do not immediately detect the main problem - the actual calculous cholecystitis.
• Saint's syndrome. It is a very rare and under-researched genetic disease. With it, the patient has a tendency to form stones in the gallbladder ( actually calculous cholecystitis), which appears to be due to the absence of certain enzymes. In parallel, there is diverticulosis of the large intestine and diaphragmatic hernia. This combination of defects requires a special approach in treatment.

The form and stage of calculous cholecystitis are one of the most important criteria for prescribing treatment. At first, doctors usually try medication. Most often, it turns out to be effective and allows you to deal with symptoms and manifestations for a long time. Sometimes latent or mild forms are observed throughout the patient's life. However, the very presence of stones is always a threat of exacerbation. Then the optimal treatment would be cholecystectomy - complete surgical removal inflamed gallbladder along with stones.