Cholelithiasis () – the disease which is followed by formation of stones in a gall bladder () or in bilious channels (). Stones are formed as a result of sedimentation of bilious pigments, cholesterol, some types of proteins, salts of calcium, infection of bile, its stagnation, violation of lipidic exchange. The disease can be followed by pains in the right podreberye, bilious colic, jaundice. As medical practice showed that other ways of treatment of cholelithiasis are not effective, surgery is required. Can be complicated by cholecystitis, formation of fistulas, peritonitis.
Cholelithiasis – the disease which is characterized by disorder of synthesis and circulation of bile in gepatobiliarny system as a result of violation of cholesteric or bilirubinovy exchanges, the investigation of what stones (concrements) in bilious channels and a gall bladder are formed. Cholelithiasis is dangerous by development of the heavy complications having high probability of a lethal outcome.
Risk factors of development of cholelithiasis are: advanced and senile age, reception of the medicines interfering with exchange of cholesterol and bilirubin (fibrata, estrogen in a menopause, , ), genetic factors (cholelithiasis at mother), violations of food (obesity, sharp weight loss, starvation, the increased level of cholesterol and high density lipoproteid of blood, a gipertriglitserinemiya), multiple pregnancies, exchange diseases (diabetes, fermentopatiya, a metabolic syndrome), diseases of bodies of digestive tract (a disease Krone, diverticulums of a duodenum and a bilious channel, an infection of biliary tract), post-operational states (after a resection of a stomach, a stem vagoektomiya).
The Zhelchekamenny disease develops at women much more often.
Reasons of formation of stones
In case of violation of a quantitative ratio of components of bile in an organism there is a formation of firm educations (flakes) which with the course of a disease expand and merge in stones. Most often meets at the broken cholesterol exchange (its excess content in bile). The bile oversaturated by cholesterol is called litogenny.
Excess of cholesterol is formed owing to the following factors:
- at obesity and the use of a large number of holesterinsoderzhashchy products;
- at decrease in amount of the bilious acids coming to bile (the lowered secretion at an estrogeniye, deposition in a gall bladder, functional insufficiency of hepatocytes);
- at decrease in amount of phospholipids which like bilious acids do not allow cholesterol and bilirubin to pass into a firm state and to settle;
- at developments of stagnation in system of circulation of bile (a bile condensation owing to absorption in a gall bladder of water and bilious acids).
Stagnation of bile in turn can have mechanical and functional character. At mechanical stagnation the obstacle to outflow of bile from a bubble takes place (tumors, solderings, excesses, increase in nearby bodies and lymph nodes, hems, an inflammation with hypostasis of a wall, striktura). Functional violations are connected with disorder of motility of a gall bladder and biliary tract (dyskinesia of biliary tract on hypokinetic type).
Also can lead to development of cholelithiasis infections, inflammations of bodies of biliarny system, allergic reactions, autoimmune states.
Types of zhyolchny stones
Gallstones are diverse by the size, a form, them there can be a different quantity (from one concrement to one hundred), but all of them are subdivided on primary a component into cholesteric and pigmentary (bilirubinovy).
Cholesteric stones of yellow color, consist of not dissolved cholesterol with various impurity (minerals, bilirubin). Almost vast majority of stones have a cholesteric origin (80%).
Pigmentary stones dark brown up to black color are formed at excess of bilirubin in bile that happens at functional violations of a liver, a frequent gemoliz, infectious diseases of bilious ways.
Classification of cholelithiasis
According to modern classification cholelithiasis is subdivided into three stages:
- the initial physical and chemical stage (dokamenny, is characterized by changes in composition of bile) clinically is not shown, it is possible to reveal in the biochemical analysis of composition of bile;
- the stage of formation of stones (latent kamnenositelstvo) also proceeds asymptomatically, but at tool methods of diagnostics detection of concrements in a gall bladder is possible;
- the stage of clinical manifestations is characterized by development of sharp or chronic kalkulezny cholecystitis.
Sometimes allocate the fourth stage – development of complications.
Clinical manifestations of ZhKB
The symptomatology of cholelithiasis is shown depending on localization of stones and their sizes. Depending on expressiveness of inflammatory processes and existence of functional frustration expressiveness of signs and the course of a disease changes.
Characteristic painful symptom at ZhKB – bilious or hepatic colic – suddenly arising pain expressed acute under the right edge of the cutting, pricking character. In a couple of hours pain finally concentrates in the field of a projection of a gall bladder. Can irradiate in a back, under a right shoulder-blade, in a neck, in the right shoulder. Irradiation to the area of heart can sometimes cause stenocardia.
Pain most often arises after the use of sharp, spicy, fried, fat products, alcohol, a stress, heavy physical activity, long work in inclined situation. The reasons of development of a pain syndrome – a spasm of muscles of a gall bladder and channels as the reflex answer to irritation of a wall concrements and as a result of bubble restretching excess of bile in the presence of an obturation in biliary tract. Global at obstruction of a bilious channel: bilious channels of a liver extend, increasing body in volume that responds painful reaction of the restretched capsule. Such pain has constant stupid character, often is followed by heavy feeling in the right podreberye.
The accompanying symptoms – nausea (up to vomiting which does not give relief). Vomiting arises as the reflex answer to irritation of the DPK okolososochkovy area. If inflammatory process took pancreas tissues, vomiting can be frequent, with bile, unrestrained.
Depending on expressiveness of intoxication temperature increase from subfebrilny figures to the expressed fever is observed. At obstruction the concrement of the general bilious channel and impassability of a sphincter of Oddi observes obturatsionny jaundice and decolouration a calla.
Diagnosis of cholelithiasis
At identification of symptomatology of hepatic colic of the patient direct to consultation of the gastroenterologist. Fizikalny inspection of the patient reveals symptoms, characteristic of presence of concrements at a gall bladder: Zakharyina, Ortner, Murphy. Also morbidity of skin and tension of muscles of a belly wall in the field of a projection of a gall bladder is defined. On skin note ksantema, at obturatsionny jaundice characteristic yellow-brownish skin color and a skler.
The general blood test in the period of a clinical aggravation shows signs of a nonspecific inflammation – and moderate increase in SOE. Biochemical blood test allows to reveal a hypercholesterolemia and a giperbilirubinemiya, increase in activity of alkaline phosphatase. At the cholecystography the gall bladder is increased, has limy inclusions in walls, the stones which are present inside with lime are well visible.
The most informative and the most widely applied method of a research of a gall bladder regarding a zhelchekamenny disease is ultrasonography of an abdominal cavity. It precisely shows existence of ekhonepronitsayemy educations – stones, pathological deformations of walls of a bubble, change of its motility. On ultrasonography existence of symptoms of cholecystitis is well visible.
Also allows to visualize a gall bladder and channels also MPT and KT of biliary tract. The stsintigrafiya of biliarny system and ERHPG (an endoscopic retrograde holangiopankreatografiya) are informative in respect of identification of violations of circulation of bile.
The most frequent complication of ZhKB is the inflammation of a gall bladder (sharp and chronic) and an obturation of biliary tract a concrement. Obstruction of a gleam of bilious ways in a pancreas can cause sharp biliarny pancreatitis. Also frequent complication of cholelithiasis is the inflammation of bile-excreting channels – holangit.
Treatment of cholelithiasis
Identification of presence of stones at a gall bladder without existence a cholelithiasis complication, as a rule, does not demand specific treatment – resort to so-called waiting tactics. If sharp or chronic kalkulezny cholecystitis develops, removal of a gall bladder as kamneobrazovaniye source is shown. Surgery (holetsistotomiya) band or laparoscopic depending on a condition of an organism, pathological changes in walls of a bubble and surrounding fabrics, the sizes of concrements. Holetsistektomiya from miniaccess can be always transferred to open band operation in case of technical need.
There are techniques of dissolution of concrements by means of medicines of ursodezoksikholiyevy and henodezoksikholiyevy acids, but such therapy does not lead to treatment from cholelithiasis and over time formation of new stones is possible. One more way of destruction of stones is the shock and wave lithotripsy – is applied only in case of presence of a single concrement and at the patients who are not suffering from an acute inflammation of a gall bladder or channels.
The forecast and prevention at ZhKB
Prevention of a zhelchekamenny disease consists in avoiding of the factors promoting the raised holesterinemiya and a bilirubinemiya, stagnation of bile. The balanced food, normalization of body weight, active lifestyle with regular physical activities allow to avoid exchange violations, and timely identifications and treatment of pathologies of biliarny system (diskineziya, obturation, inflammatory diseases) allows to reduce probability of a staz of bile and loss of a deposit in a gall bladder. The special attention to exchange of cholesterol and a condition of bile-excreting system need to be given to the persons having genetic predisposition to a kamneobrazovaniye.
In the presence of stones in a gall bladder observance of a strict diet (an exception of a diet of fat, fried products, fancy bread, confectionery creams, sweets, alcohol, carbonated drinks etc.), normalization of body weight, the use of enough liquid will be prevention of attacks of bilious gripes. For decrease in probability of the movement of concrements from a gall bladder on channels the work connected with long stay in inclined situation is not recommended.
The forecast of development of cholelithiasis directly depends on the speed of formation of stones, their size and mobility. In overwhelming quantity of cases presence of stones at a gall bladder leads to development of complications. During successful surgical removal of a gall bladder – treatment without the expressed consequences for quality of life of patients.
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