Gallstones Treatment

Gallstones (gallstone disease, cholelithiasis, GI, cholelithiasis) is a disease characterized by the formation of gallstones in the gallbladder, usually consisting of cholesterol. In most cases, they do not cause any symptoms and do not require treatment.

However, if the stone gets stuck in the duct (opening) of the gallbladder, it can provoke sudden severe abdominal pain, which usually lasts from one to five hours. Such abdominal pain is called biliary colic.

Gallstones can also cause its inflammation (cholecystitis). Cholecystitis can be accompanied by prolonged pain, jaundice of the skin and an increase in body temperature above 38 ° C.

In some cases, the stone, having descended from the bladder, can clog the duct through which digestive juice from the pancreas flows into the intestine. This causes her irritation and inflammation - acute pancreatitis. This condition causes abdominal pain, which is constantly increasing.

It is believed that stones are formed due to a violation of the chemical composition of bile in the gallbladder. In most cases, cholesterol levels are greatly increased, and excess cholesterol turns into stones. Gallstones are very common. In Russia, the prevalence of cholelithiasis ranges from 3-12%.

Usually, treatment is required only in cases where stones cause anxiety, for example, abdominal pain. Then a minimally invasive operation to remove the gallbladder may be recommended. This procedure, called laparoscopic cholecystectomy, is quite simple and rarely has complications.

A person can do without a gallbladder. This organ is useful, but not vital. After cholecystectomy, bile is still produced in the liver, which instead of accumulating in the bladder, drips into the small intestine. However, some of the operated patients develop postcholecystectomy syndrome.

Thus, in most cases, cholelithiasis (GI) is easily treated surgically. Very severe cases can be life-threatening, especially in people with poor health, but fatal outcomes are rare.

Usefull Information About Gallstones treatment

Many people with gallstone disease (GI) do not experience any symptoms and do not know about the disease unless stones are accidentally found in the gallbladder during an examination conducted for another reason.

However, if the stone blocks the bile duct, through which bile flows from the gallbladder into the intestine, pronounced symptoms occur.

The main one is abdominal pain. However, with a certain location of stones, other symptoms may occur against the background of pain in the gallbladder.

Stomach pain

The most common symptom of gallstones is sudden severe abdominal pain, usually lasting from one to five hours (but sometimes it can go away in a few minutes). This is called biliary colic.

Pain with biliary colic may be felt:

  • in the center of the abdomen, between the sternum and the navel;
  • in the hypochondrium on the right, from where it can give to the right side or shoulder blade.

During an attack of colic, the gallbladder hurts constantly. Emptying the intestines or vomiting does not alleviate the condition. Sometimes pain in the gallbladder is provoked by eating fatty foods, but it can start at any time of the day or wake you up at night.

As a rule, biliary colic occurs irregularly. Several weeks or months may pass between bouts of pain. Other symptoms of biliary colic may be episodes of severe sweating, nausea or vomiting.

This course of the disease is called uncomplicated cholelithiasis (GI) by doctors.

Other symptoms of gallstones

In rare cases, stones can cause more severe symptoms if they block the exit of bile from the bladder for a longer time or shift to other parts of the bile ducts (for example, block the outflow from the pancreas to the small intestine).

In such cases, you may have the following symptoms:

  • temperature 38°C or higher;
  • more prolonged abdominal pain (gallbladder);
  • rapid heartbeat;
  • yellowing of the skin and whites of the eyes (jaundice);
  • skin itching;
  • diarrhea;
  • chills or trembling attacks;
  • disorientation in space and time;
  • lack of appetite.

Doctors call this more severe condition complicated by cholelithiasis (GI).

It is believed that stones are formed due to a violation of the balance of the chemical composition of bile in the gallbladder. Bile is a liquid necessary for digestion, which is produced by the liver.

It is still not clear what leads to this imbalance, but it is known that gallstones can form in the following cases:

  • unusually high levels of cholesterol in the gallbladder - about four out of five gallstones are made up of cholesterol;
  • unusually high levels of bilirubin (the product of the breakdown of red blood cells) in the gallbladder - about one in five gallstones consist of bilirubin.

Chemical imbalance can lead to the formation of tiny crystals in the bile, which gradually turn (often over many years) into strong stones. Gallstones can be small, like a grain of sand, or large, like a pebble. Stones can be single and multiple.

Who can have gallstones?

Gallstones are more common in the following groups of people:

  • women, especially those who gave birth;
  • overweight or obese people - if the body mass index (BMI) is 25 or higher;
  • people 40 years and older (the older you are, the higher the risk of stone formation);
  • people with cirrhosis (liver disease);
  • people with diseases of the digestive system (Crohn's disease, irritable bowel syndrome);
  • people who have relatives with gallstones (about a third of people with gallstones have a close relative suffering from the same disease);
  • people who have recently lost weight, either as a result of a diet or as a result of surgery, for example, gastric banding;
  • people taking a drug called ceftriaxone is an antibiotic used to treat a number of infectious diseases, including pneumonia, meningitis and gonorrhea.

There is also an increased risk of gallstones in women taking combined oral contraceptives or undergoing treatment with high doses of estrogen (for example, in the treatment of osteoporosis, breast cancer, menopause manifestations).

If you have a gallbladder pain or have other symptoms of gallstone disease (GI), contact your therapist or gastroenterologist so that the doctor can conduct the necessary examinations.

Consultation with a doctor

First of all, the doctor will ask you about your symptoms, and then ask you to lie down on the couch and examine your stomach. There is an important diagnostic sign — Murphy's symptom, which the doctor usually checks during the examination.

To do this, you need to inhale, and the doctor will easily knock on your abdominal wall in the gallbladder area. If abdominal pain occurs during this reception, Murphy's symptom is considered positive, which indicates inflammation in the gallbladder (in this case, urgent treatment is required).

The doctor may also prescribe a general blood test to detect signs of infection or a biochemical blood test to determine how the liver works. If the stones have shifted from the gallbladder to the bile duct, the liver will be disrupted.

If your symptoms or test results indicate gallstones, most likely the doctor will refer you for additional examination to confirm the diagnosis. If there are signs of a complicated form of cholelithiasis (GI), you may be admitted to the hospital for examination on the same day.

Ultrasound examination of the gallbladder (ultrasound)

Usually, the presence of gallstones can be confirmed by ultrasound, when an image of your internal organs is created using high-frequency sound waves.

When diagnosing gallstones, the same type of ultrasound is used as during pregnancy, when a small sensor is driven along the upper abdomen, which is also a source of ultrasonic vibrations.

It sends sound waves through the skin into the body. These waves are reflected from the tissues of the body, forming an image on the monitor. Ultrasound of the gallbladder is a painless procedure that takes about 10-15 minutes. Use our service to find a clinic where they do ultrasound of the gallbladder.

Ultrasound of the gallbladder does not detect all types of stones. Sometimes they are not noticeable in the ultrasound picture. It is especially dangerous to "miss" a stone that has clogged the bile duct. Therefore, if the doctor suspects the presence of cholelithiasis by indirect signs: the results of tests, an expanded view of the bile duct on ultrasound or others, you will need several more studies. In most cases, this will be an MRI or cholangiography (see below).

Magnetic resonance imaging (MRI)

Magnetic resonance imaging (MRI) can be performed to search for stones in the bile ducts. This type of scan uses strong magnetic fields and radio waves to create a detailed image of the internal structure of your body. Find out where MRI is done in your city.

X-ray examination of the gallbladder

There are several types of X-ray examination of the gallbladder and bile ducts. All of them are carried out using a special dye - a radiopaque substance that is clearly visible on an X-ray.

Cholecystography - before the study, they are asked to drink a special dye, after 15 minutes they take a picture of the gallbladder, and then another one after eating. The method allows you to assess the structure of the gallbladder, to see the stones, their size and location, as well as to study the work of the gallbladder (how well it shrinks after eating). When the cystic duct is blocked by a stone, the gallbladder is not visible in the picture, since the dye does not enter it. Then other types of research are prescribed.

Cholegraphy is an X-ray examination of the gallbladder, similar to cholecystography. But the dye is injected into a vein.

Cholangiography is an X-ray examination of the gallbladder when the dye is injected into the bile ducts either through the skin (using a long needle) or during surgery.

Retrograde cholangiopancreatography (RHPG) is a method of X—ray examination of the gallbladder and bile ducts, using endoscopic techniques. RHPG can only be a diagnostic procedure or, if necessary, expand to a therapeutic one (when stones are removed from the ducts using endoscopic technique) - see the section "Treatment of gallstones".

During retrograde cholangiopancreatography, the dye is injected using an endoscope (a thin flexible tube with a light bulb and a camera at the end), which is passed through the mouth into the esophagus, stomach, and then the duodenum - to the place where the bile duct opens.

After the introduction of the dye, X-rays are taken. They will show any abnormalities in the gallbladder or pancreas. If everything is in order, then the contrast will flow freely into the gallbladder, bile ducts, liver and intestines.

If an obstruction is detected during the procedure, the doctor will try to eliminate it with an endoscope.

Computed tomography (CT)

If complications of cholelithiasis (GI) are suspected, for example, acute pancreatitis, you may be prescribed a computed tomography (CT). This type of scan consists of a series of X-rays taken from different angles.

CT is often done in an emergency to diagnose severe abdominal pain. Radiology departments are usually equipped with equipment for performing computed tomography of the abdomen.

Treatment of cholelithiasis (GI) will depend on how its symptoms affect your life. If there are no symptoms, active surveillance tactics are usually recommended. This means that you will not be prescribed any treatment right away, but you will have to see a doctor if you notice any symptoms. As a rule, the longer you do not experience any symptoms, the lower the likelihood that the disease will ever worsen.

You may need treatment if you have a disease that increases the risk of developing complications of gallstone disease, for example, the following:

  • scarring of the liver (cirrhosis);
  • high blood pressure inside the liver is called portal hypertension and often develops as a complication of liver disease caused by alcohol abuse;
  • diabetes mellitus.

You may also be recommended treatment if the examination showed a high calcium content in the gallbladder, as this can lead to the development of gallbladder cancer in old age.

If you experience bouts of abdominal pain (biliary colic), treatment will depend on how they interfere with your normal life. If the attacks are moderate and infrequent, the doctor will prescribe an analgesic to be taken during the attack, and will consult about the diet to be followed for gallstones.

If the symptoms are more severe and occur frequently, surgery to remove the gallbladder is recommended.

Laparoscopic cholecystectomy

In most cases, it turns out to remove the gallbladder with a minimally invasive intervention. This is called laparoscopic cholecystectomy. During laparoscopic cholecystectomy, three or four small incisions are made on the abdominal wall (each about 1 cm in length). One incision will be near the navel, and the rest will be on the abdominal wall on the right.

The abdominal cavity is temporarily filled with carbon dioxide. It is safe and allows the surgeon to see your organs better. Then a laparoscope (a thin long optical device with a light source and a video camera at the end) is inserted through one of the incisions. Thus, the surgeon will be able to observe the operation on a video monitor. Then the surgeon will remove the gallbladder using special surgical instruments.

To exclude blockage of the bile ducts by stones, an X-ray examination of the biliary tract is performed during the operation. The detected stones can usually be removed immediately, during laparoscopic surgery. If for some reason it is not possible to perform an operation to remove the gallbladder or stones using a minimally invasive technique (for example, complications develop), they proceed to open surgery (see below).

If the laparoscopic cholecystectomy was successful, the gas is removed from the abdominal cavity through a laparoscope, and the incisions are sewn with soluble surgical threads and closed with bandages.

Laparoscopic cholecystectomy is usually performed under general anesthesia, which means that during the operation you will sleep and not feel pain. The operation takes an hour and a half. Recovery after removal of the gallbladder with the help of minimally invasive techniques occurs very quickly, usually a person stays in the hospital for 1-4 days, and then is discharged home for further recovery. You can start working, as a rule, 10-14 days after the operation.

Removal of the gallbladder with a single puncture (sils-cholecystectomy) is a newer type of surgery. During it, only one small puncture is made in the navel area, which means that you will have only one scar hidden in the fold of the navel. However, laparoscopic cholecystectomy with one incision has not yet been worked out as well as conventional laparoscopic cholecystectomy, and there is still no consensus about it. Such an operation may not be performed in every hospital, as it requires an experienced surgeon who has undergone special training.

Removal of the gallbladder through a wide incision

In some cases, laparoscopic cholecystectomy is not recommended. This may be due to technical reasons, security reasons, or the fact that you have a stone stuck in your bile duct that cannot be removed during a minimally invasive operation.

Laparoscopic cholecystectomy is not recommended in the following cases:

  • third trimester (last three months) of pregnancy;
  • obesity - if your body mass index (BMI) is 30 or higher;
  • unusual structure of the gallbladder or bile duct, which is why minimally invasive surgery is potentially dangerous.

In these cases, open (laparotomy, cavity) cholecystectomy is recommended. During the operation, an incision 10-15 cm long is made on the abdominal wall in the right hypochondrium to extract the gallbladder. Abdominal cholecystectomy is performed under general anesthesia, so that during the operation you will sleep and will not feel pain.

Removal of the gallbladder by laparotomy (wide incision) it is just as effective as laparoscopic surgery, but it takes longer to recover and leaves a more noticeable scar. It is usually necessary to stay in the hospital for 5 days after surgery.

Surgery for cholelithiasis (GI) can solve many problems, but some people have new problems after removing the gallbladder.

Therapeutic retrograde cholangiopancreatography (RHPG)

In the course of therapeutic retrograde cholangiopancreatography (RHPG), stones are removed from the bile ducts, and the bladder itself, along with the stones in it, remains in place, unless the methods described above are used.

RHPG is similar to diagnostic cholangiography (read more about this in the section "Diagnosis of gallstones"), when an endoscope (a thin flexible tube with a light bulb and a camera at the end) is carried out through the mouth to the place where the bile duct opens into the small intestine.

However, during RHPG, the mouth of the bile duct is expanded by means of an incision or by means of an electrically heated wire. Then the stones are extracted into the intestines so that they leave the body naturally.

Sometimes a small expansion tube called a stent is permanently installed in the bile duct, which helps the free passage of bile and stones from the bladder into the intestine.

Usually, sedatives and painkillers are administered before the RHPG, which means that you will be conscious, but you will not feel pain. The procedure lasts from 15 minutes or more, usually about half an hour. After the procedure, you may be left in the hospital overnight to monitor your condition.

Dissolution of gallstones

If the stones in your gallbladder are small and do not contain calcium, it may be possible to dissolve them by taking medications based on ursodeoxycholic acid.

Remedies for dissolving gallstones are not often used. They do not have an extremely strong effect. To get a result, they need to be taken for a long time (up to 2 years). After stopping taking ursodeoxycholic acid, stones may form again.

Side effects of ursodeoxycholic acid are rare and, as a rule, easily expressed. The most common of them are nausea, vomiting and itching of the skin.

Ursodeoxycholic acid is not recommended for pregnant and breast-feeding women. Women taking drugs to dissolve gallstones, living a sexual life, should use barrier methods of contraception, such as condoms, or oral contraceptives with a low content of estrogen, since other contraceptive drugs can reduce the effectiveness of treatment with ursodeoxycholic acid.

Ursodeoxycholic acid preparations are also sometimes prescribed as a prevention of the formation of gallstones if you are at risk. For example, you may be prescribed ursodeoxycholic acid if you have recently had an operation to lose weight, as a sharp weight loss can provoke the formation of gallstones.

Diet for cholelithiasis (GI)

In the past, people who could not have surgery were sometimes advised to reduce their fat intake to a minimum in order to stop the growth of stones.

However, recent studies have shown that this does not help, since a sharp weight loss as a result of a reduction in fat in the diet, on the contrary, can cause the growth of gallstones.

Therefore, if surgery is not recommended for you or you would like to avoid it, you should eat healthy and balanced food. This implies the use of a variety of foods, including a moderate amount of fat, and regular meals.

A healthy diet will not cure cholelithiasis (GI) and will not eliminate your symptoms, but it will help improve the overall condition of the body, make attacks of biliary colic less frequent.

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