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Gallstones: symptoms and treatment without surgery

Gallstone disease is a fairly common disease. Often people, knowing about the presence of stones in the gallbladder, do not pay enough attention to their health.

Usually such ignoring of the pathological process leads to an emergency operation, and sometimes to severe complications. To get rid of the disease without surgery, everyone should know what the first symptoms give gallstones, their treatment and prevention of recurrence.

Content

Gallstone disease: what is it?

Stones formed in the gallbladder and ducts are fairly solid compounds of calcium salts, bile pigment bilirubin or cholesterol. ZhKB is more common in obese women, the peak of the disease occurs at the age of 70 years.

A high percentage of the disease in elderly people is due to physiological reasons: with age, the process of bile formation slows down, and the contractile function of the gallbladder becomes insufficient.

However, sometimes stones in the ducts of the gallbladder are diagnosed in children, even in newborns.

Causes of gallstones

Gallstones

Gallstone disease can be called a lifestyle indicator. It is the human habits (eating habits, motor mode), due to the modern realities of life, lead to the development of JCB. A high percentage of morbidity is recorded in developed countries.

Factors provoking stones in the gallbladder ducts:

  • nutritional oversights - snacking, overeating, grueling diets and starvation, high-calorie menu (fats, proteins predominate) with insufficient fiber content;
  • lack of physical activity, sedentary work;
  • regular hypothermia, living in a cold climate;
  • liver pathology - biliary duct dyskinesia, cholecystitis, abnormal liver function (cirrhosis, hepatitis, liver cysts, toxic effects, side effects of Cyclosporine, Octreotide, etc.) with a decrease in bile acid production and an increase in cholesterol in bile;
  • obesity;
  • childbirth (especially for women with many children);
  • long-term use of estrogen-containing tablet contraceptives;
  • genetic predisposition to liver diseases;
  • other diseases - diabetes mellitus, severe allergies, hemolytic anemia, Crohn's disease, duodenal diverticula.

The mechanism of development of gallstone disease

The precursor of JCB is always a thickening of bile, the formation of biliary sludge and, as a rule, a decrease in the contractile ability of the gallbladder.

The grease-like bile gradually condenses, turning first into small stones (sand), and only then very dense structures are formed, increasing with time in diameter.

When exposed to any irritating moment (feast, shaking ride, etc.), the stones can begin to move and sometimes block the lumen of the bile ducts, provoking an acute clinical picture.

Types of gallstones

By type of education gallstones are divided into:

  • primary - the process of stone formation is triggered by a violation of the composition of bile;
  • secondary - stones are formed due to cholestasis and the subsequent inflammatory process.

Composition gallstones are:

  • cholesterol - up to 80% of all dense structures in the gallbladder;
  • pigment (bilirubin) - often are the result of hemolytic anemia;
  • calcareous - due to secondary calcification of pigment and cholesterol inclusions, less often primary hypercalcemia.

Symptoms of Gallstones

symptoms of gallstones

Small gallstones usually form without symptoms. Only when their size or number reaches a sufficient size, there are pronounced symptoms of the disease.

Large, multiple calculi put pressure on the walls of the gallbladder, causing painful sensations and an inflammatory reaction. In this case, at any time there may be an acute condition that requires emergency medical care.

If the stone of small size passes the biliary tract, the colic passes, the condition improves, and the stone comes out with feces. Often, large stones get stuck in the bile ducts and, completely blocking their lumen, provoke the development of cholecystitis and jaundice.

Signs that help to suspect gallstones:

  1. heaviness in the right hypochondrium;
  2. belching rotten egg, nausea;
  3. the passing pains, especially after a plentiful feast, an exercise stress;
  4. bitterness in the mouth.

Such mild symptoms of JCB can last up to 5-10 years. The only sign of a weak symptom course of the disease may be the yellowness of the skin and eyeballs.

Often there is calculous cholecystitis, manifested by:

acute biliary colic attack

Sooner or later, the stones begin to move along the bile ducts and there is an attack of acute biliary colic :

  1. cutting pain radiating to the lower back, right forearm and scapula, sometimes behind the sternum (simulating an attack of angina pectoris);
  2. nausea, vomiting without relief;
  3. flatulence and belching air.

Most patients note a clear relationship between the onset of an attack and the effect of a colic-precipitating factor.

Diagnosis of the disease

Often, stones in the ducts of the gallbladder are found by chance during an ultrasound or x-ray. A qualified specialist in the results of research will determine not only the size of the stones and the presence of inflammation, but also determine the approximate composition of stones, assess the risk of biliary colic.

For more information about the disease can be assigned:

  • blood tests (general and biochemistry);
  • cholecystocholangiography;
  • CT scan, MRI ;
  • retrograde cholangiography (during the endoscopic procedure, the doctor can remove small stones).

Treatment of gallstones without surgery

Therapeutic tactics - conservative or radical - is chosen only on the basis of diagnostic data. Even in the absence of severe symptoms, surgery can be ordered to remove stones from the gallbladder.

Surgical treatment is necessary for the development of persistent cholestasis (obstructive jaundice), intractable medication or frequently recurring biliary colic, large sizes of stones, recurrent cholecystitis.

Conservative therapy is appropriate for stones with an aggregate (total) diameter of less than 2 cm, good contractility of the biliary tract (not less than 75%).

Non-surgical treatment includes the following activities:

Diet number 5 (Pevzner)

The transition to plant foods and dairy products. Especially useful are vegetables (pumpkin, carrots), cereals (oats, buckwheat), watermelon, apples, wheat bran. Diet with stones in the gall bladder excludes fatty, spicy, fried.

Prohibited chocolate, alcohol, condiments, coffee / cocoa, pork / lamb, cucumbers, eggplant, beans, smoked meats. Protein is replenished by the use of lean meat and fish. Nutrition fractional portions up to 6 times a day.

Symptomatic treatment

no-shpa in the treatment of gallstones

Antispasmodics (Papaverin, No-Shpa), analgesics (Baralgin, Spazmalgon), antibiotics (Clarithromycin, etc.) are used for the occurrence of cholecystitis.

Medical dissolution of stones

Drugs with chenodeoxycholic and ursodeoxycholic acids are widely used. Such treatment is advisable only with stones up to 2 cm in diameter. The course is up to 1.5 years.

Stones that are very dense in structure often do not respond to medication effects. The efficiency of manipulation ranges from 40 to 80%, in 2/3 of patients relapses occur.

Shock wave lithotripsy

non-surgical removal of gallstones

Lithotrapsy procedure is one of the methods of non-surgical treatment of gallstones, photo

The painless crushing of gallstones with ultrasound helps to destroy the stones up to 3 cm (no more than 3 pieces!), The fragments of which easily leave the gall bladder.

Outpatient procedure. Course - 1-7 sessions.

Surgery for gallstones

Surgical treatment is carried out in two ways:

  • classical - open cholecystectomy - removal of the gallbladder through a wide incision;
  • laparoscopic - cholecystectomy is performed through punctures of the abdominal wall, the operation is minimally traumatic, and recovery takes up to 5 days.

The patient should be aware of the post-cholecystectomy syndrome: after cholecystectomy, there is often pain in the right hypochondrium, a metallic taste in the mouth and bitterness.

Possible complications

  • Cholecystitis.
  • The formation of adhesions in the gallbladder.
  • Pathology of the duodenum after cholecystectomy and frequent enteritis (due to the continuous flow of bile).
  • Complicated cholestasis biliary colic.

Relapse prevention

If a person starts the pathological process of stone formation in the gallbladder, it is quite difficult to completely stop it without an operation.

The patient after a mandatory course of treatment should regularly undergo a preventive examination. Even after surgery, the patient is prescribed courses of litholytic drugs.

An important point is the correction of lifestyle, especially nutrition.

Fighting overweight often helps minimize the risk of re-stone formation and significantly reduces the frequency of relapses.

Gallstones, ICD code 10

The international classification of diseases of gallstone disease is:

Class XI. Diseases of the digestive system (K00-K93)

K80-K87 - Diseases of the gallbladder, biliary tract and pancreas

  • K80 - Cholelithiasis

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