Principles of treatment of gallstone disease differ in patients with different stages of the disease, age, presence of complications. All patients need nutritional therapy is recommended. During exacerbation of gallstone disease, the presence of biliary colic, acute pancreatitis associated, in the period of acute famine in the assigned 1-2 days for schazheniya pancreas. Then maybe food for the table number of dietary 5p. This sharply limited the amount of fat in the diet. It is used in the food boiled, mashed.
Diet for uncomplicated gallstone disease:
We recommend feeding with a normal amount of protein, vitamins and trace elements.
At higher weight limit or eliminate carbohydrate. In all cases, limit the intake of cholesterol from food. Foods rich in cholesterol - is the brains, egg yolks, liver, pork, sausage, fatty milk, sour cream, fat cottage cheese, cream, duck and goose meat, cheese.
We recommend the use of products containing large amounts of protein in the form of poultry, rabbits, fish, except the oil-rich, low-fat cottage cheese.
Food should be boiled, so that more cholesterol was transferred to the broth, but in this case, you should not drink the broth.
Soups are prepared in vegetable broth, or a second broth (obtained after the first merging of broth). You can cook food in water, yogurt, juices, vegetable broths. When roasting meat, it is necessary to remove the skin before eating.
Vegetables are used in boiled, baked form, as a salad with olive oil, yogurt, low-fat yogurt.
Baked goods should not be fresh. We recommend the use of slightly stale bread and pastry products, biscuits, cakes and pastries should be excluded from the diet.
Do not chocolate, ice cream, carbonated drinks. The liquid used in the form of weak tea, coffee, juice diluted deprived of gas mineral waters.
Patients with acute gallstone disease - hepatic colic appointed painkillers until the narcotic analgesic, antispasmodic drugs intravenously and intramuscularly to the disappearance of pain. Upon detection of inflammation in the biliary tract antibiotics penicillin, tetracycline, erythromycin, nitrofuranovogo drugs. With concomitant chronic pancreatitis appointed enzymes (Festal, Creon, panzinorm, mezim).
In order to improve liver function can be assigned hepatoprotectors (LIV52, gepatofalk, Essenciale, Kars, hepatitis, SAMe). If gallstones are in small numbers, swim, do not occupy more than one third of the lumen of the gallbladder, and it does not provide shade on holetsistogrammah (that are presumably cholesterol) attempts to dissolve them. For this patient prescribers henodezoksiholevoy (henofalk) or ursodeoxycholic (ursofalk) acids.
Prerequisite for the dissolution of the stones is the preservation of normal function of the gallbladder, especially his ability to concentrate bile. Other drugs that dissolve the stones do not accumulate in sufficient quantities in the gallbladder. The patient should not be inflammation in the gallbladder and bile ducts as bile acids and of themselves can cause an inflammatory reaction. Preparations of bile acids and henofalk ursofalk inhibit cholesterol synthesis in the body, reducing its excretion in the bile, increase the content in the bile of bile acids, is separated from the stones of cholesterol microcrystals and is removed from the bile.
Treatment of long-term, 6-8 months. The criterion of treatment success - no stones by ultrasound. If successful, the dissolution of the stones, the maintenance dose of the drug shall be appointed for a further period of 3 months to prevent recurrence of stone formation. During treatment, the patient should follow a diet with a reduced amount of cholesterol in the diet, with adequate fluid intake. The best effect is obtained by combined use of henofalka and ursofalka. Doses are calculated based on the weight of the patient. Drugs are taken once a day, at night, as the night increased the secretion of bile and its accumulation in the gallbladder.
Dissolution of gallstones is contraindicated in pregnancy, because drugs are bad bile acids may affect the fetus.
One of the modern methods of treatment of gallstone disease is a shock wave cholelithotrity. This method is based on the fragmentation of stones in the gall bladder into small pieces using sound waves. Fragmentation is possible with large stones in the gall bladder, but their size should not exceed 3 cm in diameter.
During the 1-2 months prior to the procedure prescribers ursodezoksi-cholic acid or henodezoksiholevoy. These drugs are used, and within 6 months after lithotripsy to prevent recurrence of stone formation. The stones under the influence of sound waves break up into smaller pieces that go on their own bile into the intestine ways.
However, sometimes complications may occur: blockage of the bile duct stone debris, the development of jaundice, acute cholecystitis or pancreatitis. To reduce the risk of complications the patient is recommended a strict diet, intake of antispasmodic drugs.
In the presence of stones or debris in the ducts is sometimes carried out endoscopic papillosphincterotomy. The main method of surgical treatment of gallstones is removal of the gallbladder. Since the early nineties, it uses a laparoscopic cholecystectomy. It has significant advantages over a large abdominal surgery.
Laparoscopic gallbladder removal is much less traumatic for the patient, no postoperative scar large, low probability of suppuration of joints after surgery, significantly reduced the postoperative period. Such surgery is possible in patients with gallstones.
If you find the stones in the ducts, surgery is usually combined. The gallbladder is removed through the laparoscopic and the stones removed from the duct using an endoscope, and sphincterotomy. If it is impossible to perform laparoscopic cholecystectomy surgery is common.
