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Zhelchekamenny illness, fight against stones in a gall bladder
Cholelithiasis (other name a cholelithiasis) is an illness of which emergence of stones in zhelchevyvodyashchy ways is characteristic. In particular, stones are formed in a gall bladder (it is about a cholecystolithiasis) and in bilious channels (the choledocholithiasis in that case develops).
Emergence of stones in development of cholelithiasis happens owing to sedimentation of insoluble components of bile. These components are cholesterol, calcium salts, bilious pigments, and also certain types of proteins. Also in certain cases concrements, pure from the point of view of chemical composition, meet. Stones which are formed in bilious channels and a bubble subdivide on cholesteric, pigmental, and also rare which are made by calcium carbonate. If it is about the mixed stones, then they, as a rule, consist of cholesterol for 70%.
It is considered to be that cholelithiasis is one of the most often found problems in gastroenterology.
As the medical statistics testifies, in recent years the number of the diseased with a cholelithiasis considerably increased: so, for 25 flyings the number of patients with cholelithiasis increased approximately by 2,8 times.
Symptoms of a zhelchekamenny illness are generally shown at people on average, and also at advanced age. However it is possible to ache with this illness at any age. The disease occurred even at newborn babies. Among total quantity of patients women prevail, but also at men stones in a gall bladder are formed rather often.
Till today mechanisms which lead to forming of stones completely are not opened. It is accepted to allocate three stages of their education: stages of saturation, crystallization and subsequent growth. The most important the bile saturation stage is considered cholesterol. In bile cholesterol is dissolved by means of difficult chemical process which is defined by a ratio of other lipids of bile.
Specialists allocate some reasons owing to which at the person cholelithiasis can develop. As basic reasons display of an illness it should be noted stagnation of bile, disturbance of exchange processes, and also an infectious factor.
Disturbance in an organism of a cholesteric exchange and, as a result, leads increase of level of cholesterol in bile and blood to emergence of stones in a gall bladder. Researches demonstrate that development of cholelithiasis is often observed at corpulent people. At obesity the bile litogennost in view of too high level of secretion of cholesterol raises.
One of the important factors influencing emergence of stones in a gall bladder is food. To the people inclined to this illness, the special diet at cholelithiasis including as little as possible cholesterol more products with food fibers is recommended. Except obesity the hypodynamia and advanced age of the person is considered the factors promoting a lithogenesis. There are also researches which confirm that cholelithiasis develops at the men and women who are ill a diabetes mellitus, atherosclerosis more often.
At women one of provocative factors is incubation of the child. In the course of growth of a fruit there is a compression of a gall bladder owing to what there is a stagnation of bile. On deadlines for pregnancy bile is saturated with cholesterol that also promotes forming of stones. Cholelithiasis is more often shown at the woman after the second pregnancy.
Cholesteric stones are often formed in the presence at the person of other diseases of a gall bladder or a gastrointestinal tract. Concentration of cholesterol increases at an irritable colon, dysbacteriosis.
Therefore, cholelithiasis is the polyetiological disease caused by different factors which set as a result leads to formation of stones in a gall bladder.
Cholelithiasis is shown at the person by very different symptoms. Specialists distinguish several different forms of a disease. It is latent, dispepsichesky, painful torpid and pristupoobrazny painful forms.
When the period of a latent form of an illness comes to the end, initially the patient can note manifestation of dispepsichesky frustration. After a while it already has a moderate pain syndrome, and after the person periodic attacks of bilious colic already disturb. But not always cholelithiasis develops according to the described scheme.
Stones in a gall bladder or channels not always provoke clinical displays of a disease. Sometimes existence of one concrement in the field of a bottom of a gall bladder does not cause manifestation of notable symptoms. Duration of a latent form of a disease can make from 2 to 11 years.
Upon transition to a dispepsichesky form of an illness at the patient the general dispepsichesky frustration which are often shown at gastrointestinal tract diseases are already noted. In the field of the right hypochondrium and epigastriums the heavy feeling is noted, in a mouth dryness and bitterness periodically appears. Heartburn attacks, a constant eructation, abdominal distention and an unstable chair are possible. At the same time the patient badly feels after the use of fat and spicy food. Such symptoms arise at this stage of a course of a disease regularly.
At a painful torpid form of cholelithiasis of pronounced attacks of pain at the person it is not observed. The stupid and aching pain in epigastriums, feeling of strong weight in right hypochondrium is sometimes shown. More intensive pain takes place after violations of the rules of food at cholelithiasis. Besides, pain becomes intensive after strong jolting, notable exercise stresses, unpleasant emotions, change of weather conditions. Pain often irradirut in the right shoulder and a right shoulder-blade. Some people are overcome by frequent nausea, heartburn, abdominal distention, constant feeling of an indisposition. Symptoms of a zhelchekamenny illness at women are characterized by strengthening of pain in days of periods. Such form of an illness can last even several decades, being followed in the absence of adequate therapy by attacks of bilious colic or acute cholecystitis.
It is also accepted to call a painful pristupoobrazny form bilious colic. It proceeds wavy: against a normality suddenly there is a heavy attack of colic. At the same time such attacks can be shown both several days later, and several years later. Pain at bilious colic very sharp, pricking or tearing apart. It is localized in the field of the right hypochondrium or in epigastric area. At the same time the person suffers strong tortures, cannot find suitable position of a body, even shouts from pain.
Sometimes such attacks are shown without the reasons, very often they are provoked by greasy or spicy food, other derogations from a diet, and also reception of alcohol, exercise or emotional stresses. Women often suffer from colic in days of periods, during pregnancy. Pain at bilious colic often gives for a right shoulder-blade, to a clavicle and supraclavicular area, a neck, the right shoulder, for a breast. In more exceptional cases pain gives to the area of heart and can be mistakenly taken for a stenocardia attack. Often during pain nausea, a cholemesis which to the patient does not give relief is noted. If at an attack of bilious colic of people suffers from pernicious vomiting, then it can demonstrate that also the pancreas was involved in pathological processes.
The strongest attacks of colic are noted at those people who have stones of the small size in a gall bladder. At the people having bilious colic in a mouth bitter taste is noted, heartburn, a meteorism can torment them, they do not transfer fried and fat food.
Complications of cholelithiasis
If in development of cholelithiasis the inflammation, an infection joins it or obstruction in bilious ways owing to movement of stones develops, then the clinical picture of an illness considerably changes. At obstruction of a channel or a neck of a gall bladder perhaps gradual development of an edema of a gall bladder. At the same time the person suffers from the strongest attack of pain, and after a while the doctor can probe the increased gall bladder. If at the patient an edema develops, then sharp attacks of pain are gradually replaced by feeling of weight in right hypochondrium. At the same time fervescence or changes at a laboratory blood analysis is not noted. But at accession of an infection the empyema of a gall bladder develops already. At such diagnosis there is a sharp aggravation of symptoms of the patient: it is overcome by pains, a fever, considerable increase of body temperature is noted.
If there is a full obstruction of an entrance to a gall bladder a stone, there is impossible an outflow and intake of bile. As a result the bubble will atrophy over time.
Sometimes a certain movement of stones promotes hit of bile in a duodenum. At the same time at the person jaundice develops. The hepatomegalia is a consequence of stagnation of bile in a liver; also the inflammation of bilious ways provoking a cholangitis can become complication of cholelithiasis.
If process passes into a chronic form, then it is fraught with manifestation of irreversible changes: cirrhosis, cholangiohepatitis, hepatonephric insufficiency. As complications of the progressing illness also development of bilious peritonitis, a pancreatonecrosis is possible. Such states it is necessary to treat urgently by exclusively surgical method.
Most often destructive cholecystitis, perforation of a gall bladder becomes complication of a cholelithiasis.
Development of cancer of gall bladder can become serious complication of long existence of stones. Seldom there is a cholelithic impassability of intestines.
Diagnosis of cholelithiasis
Statement of the diagnosis in case of cholelithiasis, as a rule, does not cause special difficulties if at the patient the attack of bilious colic develops. It is more difficult to diagnose an illness in the presence of indistinct pain, dispepsichesky symptoms, or symptoms of pathology of other bodies of a gastrointestinal tract. One of the major moments in the course of diagnosis is the correct anamnesis from which the doctor can learn about all features of a course of an illness.
In the course of diagnosis an informative method is the laboratory blood analysis, and also a calla and urine.
Sometimes the patient with suspicion appoint carrying out duodenal sounding to existence of stones in a gall bladder. Carrying out biochemical research of bile allows to estimate properties of bile which somewhat depend on existence of pathological process in zhelchevyvodyashchy ways. However in view of a possibility of an exacerbation of an illness after carrying out duodenal sounding radiological, and also ultrasonografichesky methods of research which allow to confirm the diagnosis are more often applied now. Completely to make sure of correctness of the diagnosis, ultrasonography, and also a method of the peroral cholecystography and an infusion cholegraphy is carried out. The modern method of a holangiografiya allows to receive pictures of bilious ways after direct introduction to them of a contrast agent. It is done by means of endoscopy, puncturing an abdominal wall. In the course of research the computer tomography and a magnetic and resonant tomography is also applied.
Treatment of cholelithiasis
That treatment of a zhelchekamenny illness had the most notable effect, it is important to approach differently the principles of therapy at patients of different age, at different stages of an illness. It is necessary to consider existence or lack of complications also. The healthy nutrition at a zhelchekamenny illness is important for all patients in whom stones in a gall bladder were found.
In the presence the patient has exacerbations of a disease, an attack of bilious colic he should not eat food for one-two days at all to provide the sparing mode for a pancreas. Further it is necessary to eat exclusively boiled, wiped, low-fat food.
At a bad attack of an illness to the patient medicines with analgesic effect are appointed. In especially hard cases purpose of narcotic analgetics, and also administration of spasmolytic drugs intravenously is possible. If in the course of diagnosis development of an inflammation in bilious ways was revealed, the course of complex therapy joins antibiotics. If cholelithiasis is accompanied by pancreatitis, reception of fermental drugs – a mezim, festal, a kreon is reasonable.
Perhaps also purpose of drugs which improve work of a liver — Essentiale, a gepatila, Karsila. If only single, floating stones in a gall bladder are found, treatment can consist in attempt of their dissolution. As drugs which promote dissolution of stones drugs of chenodesoxycholic or ursodezoksikholevy acids are used.
That dissolution of stones took place successfully, important that normal functions of a gall bladder were kept, there was no inflammation in bilious ways and a gall bladder. The specified drugs promote cholesterol synthesis reduction, reduce its allocation with bile, promote separation of crystals of cholesterol from stones and their removal with bile.
Such treatment can last more than half a year. For treatment it is important to patient to keep to a diet which will include a minimum of cholesterol and a lot of liquid. However such treatment is contraindicated to pregnant women as drugs can exert a negative impact on a fruit.
Shock and wave cholelithotripsy is a modern technique of treatment of a zhelchekamenny illness which consists in crushing of stones. The sound wave is for this purpose used. That crushing was successful, the size of a stone should not make more than 3 cm in the diameter.
The surgery at a zhelchekamenny illness assumes full removal of a gall bladder. Today for this purpose the laparoscopic cholecystectomia is mainly applied. Such technique of removal of a gall bladder is much less traumatic, the postoperative period lasts much more a smaller span. Such operation can be done if the purpose is the removing calculus from a gall bladder.
At stones in a bilious channel the combined operation is performed: by means of a lapraskopichesky method the gall bladder is removed, and from bilious channels extraction of stones is carried out with use of the endoscope and a sphincterotomy.
Diet at cholelithiasis
Treatment of this illness is impossible without strict observance of some principles of food. The diet at stones in a gall bladder can effectively relieve of frequent emergence of unpleasant symptoms of cholelithiasis.
Its basic principle is restriction of food which contains cholesterol. People with stones in a gall bladder should not use cheese, brains, an egg yolk, a liver, sausages, pork, fat dairy products, meat of a duck and goose.
If at the patient existence of excess weight is observed, then it needs to exclude digestible carbohydrates from the menu.
It is important to eat the products supporting squirrels regularly. The diet at a zhelchekamenny illness assumes the use of fish, fowl, a rabbit, low-fat cottage cheese. To reduce the content of cholesterol in products, they should be boiled, but at the same time not to drink broth. Food needs to be eaten in the baked, boiled, stewed look. If meat is baked, then skin before its use needs to be deleted.
Vegetable salads refuel kefir, olive oil. It is impossible to eat fresh bread: it is better to take a little stale piece of bread or crouton. It is important to increase the regular use of cellulose, entering as much as possible vegetables into a diet. It is not necessary to limit the everyday use of liquid drinks as they promote an exit of toxins from an organism, and also supports normal exchange processes.
The diet at stones in a gall bladder excludes inclusion in a diet of aerated water, ice cream, chocolate. Fat dishes significantly load a gall bladder. It is necessary to eat rather small portions, dividing the general day diet into 6-7 meals.
Prevention of cholelithiasis
Not to allow development of cholelithiasis it is important to remove quickly all causes which promote disturbance of exchange processes and stagnation of bile. To the people inclined to formation of stones in a gall bladder, and also that who has other diseases of a gastrointestinal tract it is necessary to pay special attention to a food allowance, having excluded, whenever possible, food which is forbidden to be used at a special diet. It is necessary to eliminate locks, not to wear hard belts, to provide everyday active lifestyle.
In view of the fact that in an organism synthesis of cholesterol comes from glucose, it is important not to abuse sugar, and also the products supporting him.
Because the intensive growth of stones is observed generally at night, it is necessary to try to empty a gall bladder before going to bed. For this purpose approximately in two hours prior to a dream it is possible to use cholagogue products — tea or kefir with honey, mineral water.
If the latent course of a disease is diagnosed for the patient, to it it is necessary to visit not less once a year the specialist gastroenterologist.