gallstone disease in adults

Cholelithiasis (GSD) or calculous cholecystitis is one of the most common diseases in the practice of gastroenterologists. Every year, more than half a million gallbladder surgeries are performed worldwide. More often, only the appendix is ​​operated on for the gallbladder. Today, cholelithiasis is diagnosed in every 10 inhabitants of the planet, and Russians and Europeans suffer from this disease more often than Asians. The disease also has gender characteristics. According to observations, women of childbearing age are more susceptible to it. After menopause, the probability of disease in the weaker and stronger sex is compared. Doctors say that the number of cases is growing, and their age is decreasing. In other words, today even very young people can get sick with cholelithiasis.

What is gallstone disease

This is a pathology associated with the gallbladder – an organ-capacity for collecting bile, which is produced by the liver for digestion processes.

The composition of bile includes a strictly balanced content of phospholipids, cholesterol, bile acids, bilirubin and salts, and its movement along the biliary tract occurs with the joint work of all digestive organs. When all the components of the general mechanism work in harmony, bile waits in the gallbladder to be in the intestines at the time of digestion and before it begins.

Gallstone disease is one of the options for the failure of this system. The disease is associated with metabolic disorders, including an increase in the level of “bad” cholesterol and bilirubin. In the gallbladder and its ducts, the composition of bile changes and the amount of salts increases. As a result, it stagnates, and harmful substances accumulate. Over time, they harden and turn into stones.

Gallstone disease can occur in chronic and acute form. In the initial phase, the disease does not cause any discomfort and therefore goes unnoticed for a long time. From the initial stage of the disease to the acute and inflammatory phase, it can sometimes take years. Most often, pathology is detected at the stage of calculus formation. Stones can close the passage in the gallbladder and damage its tissues. This is accompanied by bouts of severe colicky pain due to the movement of stones. Sometimes stones, if they are small in size, can come out on their own, but this feeling is very unpleasant. Excretion of stones can be facilitated by physical activity, injury, too hot bath or inflammation in the gallbladder. Large stones should not be allowed to come out, as they can clog the ducts, which is very dangerous.

Gallstones are classified according to their shape, size, quantity and composition. Most often, stones are formed from cholesterol, bilirubin. Such stones are distinguished by their yellow color and, as a rule, are small in size, which makes them easier to treat. Soft and oily in consistency, black or brown calculi are called pigmented and are diagnosed less frequently. There are also calcareous and mixed types of stones. Lime stones can be very large.

Depending on the localization, 3 forms of cholelithiasis are distinguished:

• cholecystolithiasis – stones in the gallbladder;
• choledocholithiasis – stones in the bile ducts, observed in every fifth case of cholelithiasis;
• intrahepatic cholelithiasis – stones in the liver, usually together with stones in the gallbladder and in the bile duct.

Causes of gallstone disease in adults

Gallstone disease is classified as a disease in which it is difficult to determine any one cause. There are several theories for the formation of stones. According to one of them, the cause is chronic infections of bile in the lumen of the gallbladder, on the other – in violations of cholesterol metabolism, on the third – in a high level of cholesterol against the background of a decrease in the volume of bile acids.

The development of cholelithiasis is often preceded by the appearance of a precipitate of cholesterol crystals, calcium salts, bilirubin pigments and other substances against the background of bile stasis. The flake-like sediment is called biliary sludge. It can disappear on its own and reappear. Over time, the process becomes pathological. Small crystals merge into sticky grains of sand, which harden and form stones.

Gallstone disease can develop in anyone, but there are a number of factors that increase its risk, these are:

• female;
• elderly age;
• genetics – the disease is often inherited;
• malnutrition and overweight;
• violation of lipid metabolism;
• diet;
• bad habits;
• sedentary lifestyle;
• diabetes;
• taking certain medications;
• bacteria and microorganisms in the duodenum or bile ducts;
• cirrhosis of the liver;
• congenital pathologies of the biliary tract;
• pregnancy and hormonal imbalance.

Symptoms of gallstone disease in adults

Before the onset of biliary colic or the development of acute cholecystitis, most patients are unaware of cholelithiasis. An uncomfortable posture, junk food or alcohol can provoke an attack in a chronic form. Symptoms of the disease depend on the diameter of the stone and its location. In all cases, it is a sharp paroxysmal pain on the right under the lower ribs, a feeling of heaviness, jaundice and a feeling of a bitter taste in the mouth in the morning. You should also be aware of:

• diarrhea or constipation, replacing each other;
• weakness;
• elevated temperature;
• belching or heartburn.

A condition in which the sharp edges of stones injure the gallbladder, causing it to become inflamed, is called cholecystitis. Acute cholecystitis can be suspected if the attack does not subside within 6 hours, the pain intensifies and spreads to the entire abdominal cavity, patients have fever, nausea and vomiting.

Against the background of cholelithiasis, complications such as cholangitis, choledocholithiasis and obstructive jaundice can develop. In this case, the symptoms will be similar for the most part. When stones enter the bile ducts – choledocholithiasis – patients have discolored feces, dark urine, brown coating on the tongue, and repeated vomiting does not bring relief to the patient. In such cases, a person needs to be urgently hospitalized in a hospital.

Treatment of gallstone disease in adults

Treatment of the disease depends on the location, size and number of calculi. In the unopened stages, you can get rid of stones with the help of lithotherapy and strict diets. This method allows you to dissolve stones without a scalpel. For this, patients are prescribed drugs based on ursodeoxycholic and chenodeoxycholic acid. This technique is suitable for cholesterol stones up to 15 mm in size, provided that they fill no more than half of the volume of the gallbladder and with unobstructed ducts.

If there are a lot of stones and the gallbladder ceases to perform its functions, it is removed surgically. This almost always solves the problem with cholecystitis and does not affect the future life of a person.

Diagnostics

In gallstone disease, early diagnosis plays an important role. The earlier the disease is detected, the more likely it is to do without surgery or the more likely it will be planned, which reduces the risk of complications.

– Treatment of gallstone disease not started on time can lead to complications that can threaten the health and even life of the patient, – emphasizes Gastroenterologist, Ph.D. Marat Zinnatullin.

Gastroenterologists and abdominal surgeons are involved in the diagnosis and treatment of gallstone disease. To date, the most popular method is considered to be ultrasound of the abdominal cavity. It can be used to detect the formation of stones at the sludge stage. Along with ultrasound, methods such as:

• cholecystoangiography – an x-ray method with the introduction of a contrast agent with iodine;
• retrograde cholangiopancreatography – a combination of endoscopy and fluoroscopic examination;
• CT – used to clarify whether the patient needs surgery;
• MRI is an expensive study with the most accurate result.

To confirm the composition of stones use:

• duodenal sounding of the duodenum;
• oral cholecystography.

Modern treatments

These include:

• Cholecystectomy – classical band removal of the gallbladder. Despite the development of n techniques, it remains the main method of treating cholecystitis. Assign with the ineffectiveness of the diet and ultrasound methods.
• Laparoscopy – the most sparing surgical intervention, which is performed through mini-punctures using a laparoscope. Either the gallbladder is removed or the stones are removed.
• Crushing stones with a laser – in this case, the calculi are crushed into small particles. The disadvantages of the technique include the risks of injury to the mucous membrane with sharp edges of stones.
• Shockwave therapy – the destruction of stones by ultrasound, the disadvantages are the same as with laser crushing. Due to the hardness of the stones, the effectiveness of ultrasonic techniques does not exceed 25%.
• Percutaneous cholelitholysis – a rare low-traumatic method in which drugs that dissolve stones are injected into the gallbladder through a catheter. The procedure is carried out several times. Does not give a full guarantee of cure.
• Lithotripsy – the destruction of stones with the help of a shock wave under high pressure. It is carried out in several sessions and is used for a small number of large cholesterol stones.

Prevention of gallstone disease in adults at home

It consists in physical education, the fight against excess weight and in a balanced, fractional diet. Intervals between meals should not exceed 4 hours. The diet should be dominated by vegetables, herbs, bran, wild rice, from meat it is recommended to give preference to chicken, turkey, rabbit and veal, as well as dietary fish. Exceptions are fried and smoked and muffins.

Popular questions and answers

Answered popular questions about cholelithiasis Gastroenterologist, Ph.D. Marat Zinnatulin.