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The Zhelchekamenny illness is a pathological process at which in a gall bladder and channels stones (concrements) are formed. Owing to formation of stones in a gall bladder at the patient cholecystitis develops.
To understand the cholelithiasis nature, it is necessary to realize, first of all, as there is an education and transportation of bile. Cells of a human liver in days develop from 500 ml to 1 liter of bile every day. Bile is required for processing of food, especially fats.
Bile from a liver (from bilious capillaries) at first appears in hepatic channels then gets into a duodenum through the general bilious hepatic channel. Process of transition of bile to a duodenum of this channel takes place by means of a muscle which call "Oddi's sphincter". If the duodenum is empty, the sphincter is closed, and bile arrives. In this case there can be an extension of a gall bladder. In it there can be an accumulation of bile which is capable to be stored a long time there.
Features of gallstones
Gallstones (concrements) are the main display of cholelithiasis. These educations consist of bile components: bilirubin, calcium, cholesterol is a part of a stone. The size of stones can vary: they can have as the size of grains of sand, well big educations, on several centimeters in the diameter. The stone in a definite time increases: so, from the size of a grain of sand for half a year the stone can grow to 1 cm. Stones have the different form: oval, roundish stones, educations in the form of a polyhedron, etc. meet. Durability of concrements also varies: both very strong stones, and brittle which are scattered from a touch meet. On a surface of stones cracks, thorns are sometimes observed, however it can be and equal. Most often stones in a gall bladder meet. This state it is accepted to call a cholelithiasis or kalkulez a gall bladder. In more exceptional cases at the person the choledocholithiasis is shown, that is stones appear in bilious channels of a liver. Concrements are formed in bilious ways both on one, and on several tens. Sometimes their quantity is estimated in hundreds. But even one stone is capable to provoke serious complication of a disease. At the same time small stones are considered more dangerous.
Reasons of a zhelchekamenny illness
Today there is no only exact theory which would explain the reason and process of emergence of gallstones. As the most probable causes of this disease it is considered to be disturbances in exchange processes of an organism, the inflammations arising in the field of a wall of a gall bladder, congestive processes in bilious ways and also other phenomena. As a rule, basic reasons in view of which at the person symptoms of a zhelchekamenny illness are shown call unhealthy way of life in general and irrational food in particular. Also other factors are important: insufficient activity, an overeating or irregular acceptance of food, sedentary work can provoke development of a zhelchekamenny illness. At women the disease is shown more often than at men, at the same time are most subject to a zhelchekamenny illness of the woman which had several childbirth.
Symptoms of a zhelchekamenny illness
In view of probability of congestive processes in a gall bladder exactly there stones are formed most often. In certain cases symptoms of a zhelchekamenny illness are not shown throughout a long span after formation of stones. Concrements sometimes do not influence functions of a gall bladder therefore the person can not suspect at all that it has stones.
However very often stones which appeared in a gall bladder provoke emergence of a spasm or cause expansion of a gall bladder. In this case symptoms of a zhelchekamenny illness are shown by painful attacks. Pain which is localized under the right costal arch can be short or long, at the same time pain has different intensity. If inflammatory process in a wall of a gall bladder is not shown, then pain can disappear without any effects. In that case it is accepted to call the similar phenomena hepatic or bilious gripes.
At a zhelchekamenny illness pain sometimes gives to the area of shovels, especially for a right shoulder-blade. Sometimes pain gives also to the area of heart. At the same time arrhythmia is sometimes shown: the rhythm of reductions of heart is broken. Often pain is shown after the person ate something acute or fat. For digestion of such products bile is necessary, therefore, there are reductions of a gall bladder. Vomiting can sometimes be shown.
If the acute inflammation of a gall bladder takes place, then pain can proceed, without abating, several days and even weeks. Temperature sometimes rises a little. It is important to consider that some remitting not always is a sign that the inflammation declines. It is only possible to speak about the termination of inflammatory process when pain completely is absent several days, and at the same time at the person body temperature is normalized.
If the chronic inflammation, then pain in right takes place the hypochondrium is shown periodically, it can be both strong, and aching. Also the person feels discomfort in this zone.
At development of pancreatitis as illness consequences symptoms of a zhelchekamenny illness are supplemented with manifestation of strong pain in an upper half of a stomach, about a navel. Pain can sometimes give to a waist, also at the patient abdominal distention, frequent vomiting is shown.
Complications of a zhelchekamenny illness
Emergence of stones is fraught not only disturbance of functions of bodies, but also emergence of inflammatory changes in a gall bladder and bodies, nearby. So, because of stones bubble walls can be injured that, in turn, provokes emergence of an inflammation. Provided that stones pass through a vesical channel with bile from a gall bladder, outflow of bile can be complicated. In the most hard cases stones can block an entrance and an exit from a gall bladder, having got stuck in it. At the similar phenomena there is a stagnation of bile, and these are premises to development of an inflammation. Inflammatory process can develop also for several hours, and for several days. Under such circumstances at the patient acute inflammatory process of a gall bladder can develop. At the same time both extent of defeat, and speed of development of an inflammation can be different. So, both insignificant hypostasis of a wall, and its destruction and, as a result, a rupture of a gall bladder is possible. Such complications of a zhelchekamenny illness are life-threatening. If the inflammation extends to abdominal organs and to a peritoneum, then at the patient peritonitis develops. As a result infectious and toxic shock and multiorgan insufficiency can become complication of these phenomena. At the same time there is a disturbance of work of vessels, kidneys, hearts, a brain. At a strong inflammation and high toxicity of the microbes breeding in the struck wall of a gall bladder, infectious and toxic shock can be shown at once. In this case even resuscitation measures do not guarantee that the patient will manage to be brought from such state and to avoid a lethal outcome.
Diagnosis of a zhelchekamenny illness
The main method of research in the course of diagnosis of a zhelchekamenny illness is ultrasonic research of an abdominal cavity. Also sick carrying out a holangiografiya, the cholecystography is appointed. The ultrasonography method allowed to increase diagnosis accuracy noticeably. It is very important that this research was conducted by the specialist having experience in definition of similar diseases and their features. So, sometimes, that take gut contents, other anatomical structures for stones. There is opportunity that stones will not be revealed in the course of research, it is especially difficult to define their existence in bilious channels.
Treatment of a zhelchekamenny illness
Today treatment of a zhelchekamenny illness often consists in carrying out a cholecystectomia, that is removal of a gall bladder in which stones are found. Removal of a gall bladder does not exert the defining impact on life activity of the person.
If stones freely are located in a cavity of a gall bladder and at the same time they consist only of cholesterol, and their size does not exceed 2 cm, then dissolution of stones is sometimes carried out. This procedure is made with use of chenodesoxycholic and ursodezoksikholevy acids. It is important to consider that in this case treatment to last not less than a year, and very often after a while at patients are repeatedly formed a fireplace. However the method can be rather effective. Also stones destroy, using force of the special wave created by special generators. In this case it is important that as a part of stones there was only a cholesterol, their number did not exceed three, and the size made no more than two centimeters. Also there is a number of contraindications for this method of treatment: inflammations of a gall bladder, pancreas, liver, pregnancy, aneurism of vessels of an abdominal cavity, etc.
Today treatment of a zhelchekamenny illness is carried out also using the method called by a laparoscopic cholecystectomia. Similar surgical intervention is less traumatic and is made by punctures of an abdominal wall and introduction through punctures of microsurgical tools. This method has also some shortcomings. First of all, the gall bladder can so be removed not in each case. If the structure of this zone is atypical, it is necessary to use a traditional cholecystectomia. Also this way of treatment cannot be applied in the presence of commissures and at strong inflammatory process in a gall bladder.
Diet at cholelithiasis
To warn further education of stones at a zhelchekamenny illness, the patient should adhere to the principles of balanced, healthy diet, and also to keep to specially developed diet for patients with this illness. The main feature of dietary food which has to be applied at treatment of a zhelchekamenny illness is providing the correct cholesteric exchange. It is for this purpose important to reduce food caloric content, having cleaned a certain amount of fats, carbohydrates from an everyday diet, and also to stop the use of those products which contain a lot of cholesterol. First of all, the last touches a liver, an egg yolk, fat grades of fish and meat, lard and some other products. The diet at cholelithiasis should not include dishes from the specified products.
Will help to bring out of an organism excess cholesterol magnesium salts. Therefore, in a dietary diet there have to be those products in which there is a high content of salts of magnesium. The diet at cholelithiasis has to include apricots, oat and buckwheat grain.
Cholesterol in bile has to contain in the dissolved look. For this purpose it is necessary to increase alkali level in bile. In this case it is important to include in a diet products of a plant origin, alkaline mineral waters, dishes and products with the high content of lecithin (it is in butter and in other dairy products). Besides, the diet at a zhelchekamenny illness includes many vegetables dishes. It is important to consider that all dishes have to be steamed, baked, or cook. It is necessary to eat six times a day, at the same time portions should not be too big.
At a zhelchekamenny illness it is recommended to use soups, bread in a stale look (white and gray), low-fat fish and meat, vegetables, greens, grain, dairy products.
It is necessary to salt food moderately, it is worth limiting rich bakery products.
To the products prohibited patients with a zhelchekamenny illness, specialists carried sausages, smoked products, sauces, fried food, animal fats, bean, spices and spices, cream cakes and cakes, coffee, cocoa, chocolate. Patients should keep to a similar diet for several years.
Prevention of cholelithiasis
As measures of prevention of a zhelchekamenny illness it is important to eliminate all risk factors of its emergence. It is necessary to try to lead a healthy lifestyle, to adhere to the principles of healthy nutrition, not to allow obesity. If cholelithiasis is already diagnosed for the person, then he should pass constantly surveys and consultations at the specialist.