Gallstone disease - a disease of liver-biliary system, which is characterized by the formation of stones (concretions) in the gallbladder and bile ducts. Gallstone disease has now become one of the most common disease of the gastrointestinal tract. It is estimated that 10-15% of adults have gallstones, even if you do not have other manifestations of the disease. The disease occurs in young people, patients, middle and older age, but its frequency increases with age. Most of gallstone disease among women.
The stones in the gallbladder and bile ducts are formed from the insoluble components of bile. This is usually cholesterol, bile pigments and calcium salts. In the gall bladder is an accumulation and concentration of bile between meals. When violations of the outflow of bile, changes in the physicochemical properties of bile is precipitated crystals of cholesterol from supersaturated bile. These crystals are the nucleus, which then is deposited other insoluble components of bile.
On the composition of the stones are divided into:
The most common cholesterol and mixed stones. Pigment stones are composed of bilirubin and its compounds with calcium (calcium bilirubinate) are less common. They occur mainly in people with a vegetarian diet, and in hot countries, where patients are often sick with parasitic diseases of blood with enhanced dissolution of hemoglobin and increased formation of bilirubin.
Pigment stones can be black - tight and small, and brown - the softer and larger. Brown pigment stones are rare and are usually formed in the intrahepatic bile ducts. Sometimes pigment stones are formed in the bile duct after surgery to remove the gallbladder.
Factors contributing to the development of gallstone disease and the formation of cholesterol and mixed stones are divided into general, hepatic and cystic.
Common factors that contribute to gallstones include
diseases of other organs of the gastrointestinal tract
taking of drugs.
In women, gallstone disease is more common than in men. The reasons for this are not fully understood. It is believed that women under the influence of female hormones - estrogen in the bile produces more cholesterol. Promotes the development of gallstones and pregnancy.
In patients with obesity-enhanced synthesis of cholesterol, and physical activity biliary system is reduced, which creates favorable conditions for the stagnation of bile and stone formation.
Promotes the formation of stones in the diet low in fiber and high in fat.
Facilitate the formation of stones conditions such as liver cirrhosis, Crohn's disease and other bowel diseases.
To medical drugs, which contribute to the development of gallstones include oral contraceptives and lipid-lowering drugs. Lipid-lowering drugs (miskleron, clofibrate, etc.) lead to a decrease in the amount of cholesterol in the blood, but in doing so the level of cholesterol in the bile rises. All these factors lead to oversaturation of bile with cholesterol or bile pigments.
By hepatic factors that contribute to stone formation include reducing the formation of bile acids by the liver, increasing the selection in the bile cholesterol levels. Cholesterol in the liver should turn into a fatty acid, but when a large number of liver does not have time to recycle most of the cholesterol, and it falls into the bile in unchanged form. It turns out bile supersaturated with cholesterol, which is called the lithogenic. Normal bile must contain 10 times more bile acids than cholesterol. In these circumstances, the whole cholesterol is in a state of colloidal suspensions, with a decrease in the concentration of bile acids, it is precipitated.
Reduced formation of liver bile acids leads to slow the outflow of bile, since bile acids serve as a stimulant to strengthen the outflow of bile. In addition, bile acids have bactericidal action and prevent the development of microorganisms in the bile. For cystic factors include hypotonic-hypokinetic dyskinesia of the gall bladder inflammation and other changes in the mucosa of the gallbladder wall.
Hypotonia of the gall bladder bile leads to stagnation and excessive concentrations. And the inflammatory changes of the gallbladder wall contribute to mucus cells of the mucous membrane. This mucus thickens the bile, it violates the outflow. Lumps of mucus may become the nucleus for the formation of stones. The initial stages of the disease occur unnoticed by the patient. The disease can occur for a long time, even if gallstones have formed. Sometimes gallstones are discovered by chance on ultrasound.
Currently, there are three stages of gallstone disease.
The first stage of the disease - physico-chemical. At this stage there are physical and chemical changes in the composition of bile and the prerequisites for the formation of stones. Clinically, this stage is not shown, gallstones do not.
The second stage is asymptomatic kamnenositelstvo. In the gall bladder at this stage already have stones, but do not make complaints of patients.
In the third stage, there are a variety of complications, depending on the location of the stones, their size, the functional activity of the biliary tract. The stone from the gall bladder can go into the cystic duct, the duct to block the output of the gallbladder. In this case, an attack of bilious or hepatic colic. This attack can be brief, if the stone back into the gallbladder. The stone can penetrate further into the common bile duct, and if the size of small stones (less than 5 mm), it can go through the major duodenal papilla into the duodenum and out with the feces. If the stone is retained in the common bile duct, it causes a complete or intermittent obstruction of the duct with the development of inflammation in the duct, jaundice and pain.
Adrift produce gallstones
In mild gallstone disease in a patient having occasional bouts of biliary colic, which can be easily removed medication therapy. The patient is worried about a feeling of heaviness in the right upper quadrant, periodic bouts of nausea, and constipation. In this case, if the stones are small, they are trying to dissolve with the help of drugs, or split, using special techniques (remote hardware lithotripsy).
The average degree of gallstone disease is characterized by severe attacks of biliary colic, accompanied by vomiting, severe pain. If the attack of colic, joins the inflammatory process in the gall bladder, there is a rise in body temperature, signs of intoxication and overall inflammatory response. Go to the disease may join an inflammation of the pancreas - pancreatitis. Conservative treatments are usually ineffective, so there is a need for surgical treatment.
In patients with severe gallstone diseases are frequent and prolonged bouts of biliary colic, accompanied by the phenomena of cholecystitis, pancreatitis and hepatitis. Pain and stored in the interictal period. There is jaundice, weight loss. Patients should be treated promptly, but in the long course of disease, increased incidence of postoperative complications.
The diagnosis of gallstone disease is set on the basis of typical clinical picture of disease, with the help of ultrasonic and radiographic methods, which allow you to find the stones, to specify their size and location.
Treatment of gallstone disease. Conservative treatment is only possible in some patients with mild disease course. The majority of patients surgical treatment.