Gallstones – Complications – NHS

A small number of people with gallstones may develop serious problems if the gallstones cause a severe blockage or move into another part of the digestive system.

Inflammation of the gallbladder (acute cholecystitis)

If a bile duct becomes permanently blocked, it can lead to a build-up of bile inside the gallbladder. This can cause the gallbladder to become infected and inflamed.

The medical term for inflammation of the gallbladder is acute cholecystitis.

Symptoms include:

• pain in your upper abdomen that travels towards your shoulder blade (unlike biliary colic, the pain usually lasts longer than 5 hours)
• a high temperature (fever) of 38C or above
• a rapid heartbeat

An estimated 1 in 7 people with acute cholecystitis also experience jaundice.

Acute cholecystitis is usually first treated with antibiotics to settle the infection and then keyhole surgery to remove the gallbladder.

The operation can be more difficult when performed as an emergency, and there’s a higher risk of it being converted to open surgery.

Sometimes a severe infection can lead to a gallbladder abscess (empyema of the gallbladder). Antibiotics alone don’t always treat these and they may need to be drained.

Occasionally, a severely inflamed gallbladder can tear, leading to inflammation of the inside lining of the abdomen (peritonitis). 

If this happens, you may need antibiotics given directly into a vein (intravenous antibiotics), and surgery may be required to remove a section of the lining if part of it becomes severely damaged.

Read more about acute cholecystitis.

Jaundice

You can get jaundice if a gallstone passes out of the gallbladder into the bile duct and blocks the flow of bile.

Symptoms of jaundice include:

• yellowing of the skin and eyes
• dark brown urine
• pale stools
• itching

Sometimes the stone passes from the bile duct on its own. If it doesn’t, the stone needs to be removed.

Find out more about treating gallstones

Infection of the bile ducts (acute cholangitis)

If the bile ducts become blocked, they’re vulnerable to infection by bacteria. The medical term for a bile duct infection is acute cholangitis.

Symptoms of acute cholangitis include:

• pain in your upper abdomen that travels towards your shoulder blade
• a high temperature
• jaundice
• chills
• confusion
• itchy skin
• generally feeling unwell

Antibiotics will help treat the infection, but it’s also important to help the bile from the liver to drain with an endoscopic retrograde cholangio-pancreatography (ERCP).

Find out more about treating gallstones

Acute pancreatitis

Acute pancreatitis may develop when a gallstone moves out of the gallbladder and blocks the opening (duct) of the pancreas, causing it to become inflamed.

The most common symptom of acute pancreatitis is a sudden severe dull pain in the centre of your upper abdomen, around the top of your stomach.

The pain of acute pancreatitis often gets steadily worse until it reaches a constant ache.

The ache may travel from your abdomen and along your back, and may feel worse after eating.

Leaning forward or curling into a ball may help relieve the pain.

Other symptoms of acute pancreatitis can include:

• feeling sick
• being sick
• diarrhoea 
• loss of appetite
• a high temperature
• tenderness of the abdomen
• less commonly, jaundice

There’s currently no cure for acute pancreatitis, so treatment focuses on supporting the body’s functions until the inflammation has passed.

This usually involves admission to hospital so you can be given:

• fluids into a vein (intravenous fluids)
• pain relief
• nutritional support
• oxygen through tubes into your nose

With treatment, most people with acute pancreatitis improve within a week and are well enough to leave hospital after 5 to 10 days.

Read more about acute pancreatitis.

Cancer of the gallbladder

Gallbladder cancer is a rare but serious complication of gallstones. Around 980 cases of gallbladder cancer are diagnosed in the UK each year.

Having a history of gallstones increases your risk of developing gallbladder cancer. About 4 out of 5 people who have cancer of the gallbladder also have a history of gallstones.

But people with a history of gallstones have a less than 1 in 10,000 chance of developing gallbladder cancer.

If you have additional risk factors, such as a family history of gallbladder cancer or high levels of calcium inside your gallbladder, it may be recommended that your gallbladder be removed as a precaution, even if your gallstones aren’t causing any symptoms.

The symptoms of gallbladder cancer are similar to those of complicated gallstone disease, including:

• abdominal pain
• a high temperature
• jaundice

Gallbladder cancer can be treated with a combination of surgery, chemotherapy and radiotherapy.

Gallstone ileus

Gallstone ileus is another rare but serious complication of gallstones. It’s where the bowel becomes obstructed by a gallstone.

Gallstone ileus can occur when an abnormal channel, known as a fistula, opens up near the gallbladder. Gallstones are able to travel through the fistula and can block the bowel.

Symptoms of gallstone ileus include:

• abdominal pain
• being sick
• swelling of the abdomen 
• constipation

A bowel obstruction requires immediate medical treatment. If it’s not treated, there’s a risk that the bowel could split open (rupture). This could cause internal bleeding and widespread infection.

Contact your GP as soon as possible if you think you have an obstructed bowel. If this isn’t possible, phone NHS 111.

Surgery is usually needed to remove the gallstone and unblock the bowel. The type of surgery you have will depend on where the obstruction in the bowel is.

Page last reviewed: 10 October 2018
Next review due: 10 October 2021

Gallbladder Infection Can Be Serious

Schedule Free Consultation For A Gallbladder Infection

Gallbladder infection is a common diagnosis but it can sometimes be more complicated than just an acute gallbladder infection secondary to gallstones or sludge. Nausea, vomiting, right upper abdominal pain, and sometimes fever are the most common presenting symptoms for gallbladder infection. Many patients present to a community hospital emergency room (OR) close to where they live for initial management.

Diagnosis of gallbladder infection requires right upper quadrant ultrasound to evaluate the thickness of the gallbladder wall and presence of pericholecystic fluid indicating swelling/edema around the gallbladder wall. Gallstones are often seen within the gallbladder in patients with gallbladder infection. CT scan may be needed to further evaluate the area around the gallbladder and adjacent liver. Severe gallbladder infection can cause liver abscess, fever, sepsis, and even death. The adjacent stomach and duodenum can also be affected by the severely inflamed/infected gallbladder.

Once diagnosed, the treatment for acute gallbladder infection (cholecystitis) is gallbladder removal, also known as laparoscopic cholecystectomy. When the gallbladder infection is so severe, gallbladder removal surgery is sometimes technically very difficult and it is associated with high risk of potential complications. When technical difficulty is encountered by a general surgeon, a referral to a liver surgeon or liver specialist is necessary to avoid unforeseen major complications such as bile duct leak, bile duct transection/injury, or vascular injury. Recognizing the technical difficulty is important to avoid unnecessary harm to the patients.

Concomitant liver diseases such as significant liver cirrhosis, abdominal ascites, portal hypertension, liver abscess, and liver tumors are sometimes found in patients with gallbladder infection requiring cholecystectomy. In this situation, the cholecystectomy is associated with significantly higher intra-and postoperative complications. Significant intraoperative bleeding can occur in patients with severe liver cirrhosis and portal hypertension during the gallbladder removal surgery. An extensive experience in liver surgery is needed to avoid further complications. This type of patients are often referred to a liver surgeon or liver specialist for gallbladder removal surgery. Advanced tertiary care and supporting services are needed to accomplish a safe operation, which often are not available in smaller hospitals.

A large gallstone can create a fistula between the gallbladder and the duodenum or colon. Small-bowel obstruction occurs when the large gallstone becomes impacted in the distal small bowel, requiring a surgical exploration. This condition is called gallstone ileus. In about 5-10% of patients, gallstones can travel down into the common bile duct and cause bile duct obstruction. This is called choledocholithiasis. Yellowing of the eyes and skin (jaundice), biliary infection (acute cholangitis), and sometimes acute pancreatitis when the pancreatic duct is obstructed, are frequently seen with this condition. A broad-spectrum antibiotic should be started immediately. This condition requires an advance endoscopic procedure to retrieve gallstones from the common bile duct (ERCP) prior to the gallbladder removal surgery. When the endoscopic procedure fails to retrieve gallstones from the common bile duct, a percutaneous transhepatic tube placement by an interventional radiologist becomes necessary.

When both techniques fail, then surgical operation is necessary to remove the gallstone from the common bile duct by direct opening of the the bile duct wall. This is called common bile duct exploration. This biliary surgery can be done via traditional open operation or minimally invasive technique. Advanced treatments are not available in most community hospitals. Dr. Iswanto Sucandy has become the referral surgeon for complex gallbladder and biliary diseases in Tampa area. We work in close collaboration with our interventional radiologists and interventional gastroenterologist to deliver the best care for our patients.

Management of Gallstones and Their Complications

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The sequence of biliary events preceding the formation of gallstones in humans. Gastroenterology.
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Biliary sludge. Ann Intern Med.
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The natural history of silent gallstones: the innocent gallstone is not a myth. N Engl J Med.
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1999;94:474–9.

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1999;44:187–92.

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Gallbladder Disease in Children – HealthyChildren.org

​​By: Eveline Shue, MD, FAAP​

Roughly one in five adults have gallbladder disease. Gallbladder problems such as gallstones are less likely in children and teens, but are becoming more common. Here’s what parents need to know.

What is gallbladder disease?

The gallbladder is an organ located on the right side of the body, under the liver. The liver makes bile, a fluid that helps to digest food. The gallbladder stores the bile. When your child eats, the gallbladder releases bile through ducts that connect it to the intestine.
​​

G​allbladder disease often happens when bile hardens and forms stones. It may be caused by or related to:​

What problems can gallstones cause?

Children with gallstones may have:

• Pain from stones in the gallbladder (biliary colic)

• Infection of the gallbladder (cholecystitis)

• Stones in the ducts draining the gallbladder that can block the flow of bile (choledocholithiasis)

• Inflammation of the pancreas (pancreatitis)

What are some symptoms of gallstones in children?

Gallstones do not always cause symptoms. However, children with gallstones may have pain in the upper right or middle part of the belly, just below the rib cage. The pain may feel sharp, crampy or dull and spread to the back or right shoulder. It may come and go, getting worse after eating—especially foods high in fat.

If a gallstone blocks a duct, a child may also have:

Can children have gallbladder disease without gallstones?

Children sometimes have gallbladder problems that do not result in stones. These may include:

Acalculous cholecystitis. Children sometimes develop gallbladder inflammation without gallstones.

Biliary dyskinesia. With this condition, the gallbladder has trouble squeezing to release the bile. Usually, children with biliary dyskinesia have no stones in the gallbladder.

What tests will be done to diagnose gallbladder disease?

If doctors think your child is having gallbladder problems, they may ask for:

• Blood tests

• An ultrasound to look at the gallbladder

• A magnetic resonance cholangiopancreatography (MRCP) to get detailed images of the bile ducts

• A CT scan, usually if blood tests show inflammation or infection of the pancreas

• A cholescintigraphy or hepatobiliary (HIDA) scan to look for infection or biliary dyskinesia

Note: diagnostic tests such as a cholescintigraphy or HIDA scan can have limited accuracy for non-gallstone gallbladder disease.

What can be done to make my child better?

​Observation. Many parents and kids know what foods will cause gallbladder pain. These foods are often greasy foods or foods that have a lot of fat. Sometimes, pain can be made better by not eating these foods.

Medicine. There is currently no reliable medicine to make gallbladder disease go away.

Surgery. The only dependable way to fix gallbladder disease is to remove the gallbladder with surgery, a procedure called cholecystectomy​. Gallbladder surgery, is usually done laparoscopically, using a video camera and a few tiny cuts or incisions. Your surgeon may recommend a procedure called a cholangiogram if the stones seem to be stuck in the ducts that drain bile into the intestine. This is done during surgery by putting dye into the bile ducts and taking x-rays.

Sometimes there is too much infection around the gallbladder and it is not safe to do the surgery laparoscopically. If this happens, your surgeon may need to do the surgery with one bigger incision.

Remember

Regular visits with your child’s pediatrician can help avoid gallbladder problems by keeping health conditions that can make them more likely under control.​

More Information

About Dr. Shue

Eveline Shue, MD, FAAP, a member of the American Academy of Pediatrics Section on Surgery, is a pediatric general surgeon at Children’s Hospital of Los Angeles and Long Beach Memorial Children’s Hospital.​

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Gallstones and Cholecystitis information. Treatment options

Gallstones may cause no symptoms and are occasionally discovered as an incidental finding when abdominal imaging is carried out for some other reason.

Epidemiology

^[1]

2-4% of asymptomatic patients in the adult Western world develop symptoms annually^[2]. The most common presentations are biliary colic (56%) and acute cholecystitis (36%). Other presentations and complications can occur (see below).

10-15% of people in the adult Western world develop gallstones. UK Hospital Episode Statistics’ data for the years 2003-2005 showed that 25,743 patients were admitted as an emergency with acute gallbladder (GB) disease during that period^[3].

The adage ‘fair, fat, fertile, female and forty’ is only part of the story. Other risk factors include:

• Increasing age.
• Positive family history.
• Sudden weight loss – eg, after obesity surgery.
• Loss of bile salts – eg, ileal resection, terminal ileitis.
• Diabetes – as part of the metabolic syndrome.
• Oral contraception – particularly in young women^[4].

Interesting information came from a 10-year study of necropsy findings in South East England. Female gallstone subjects had a higher BMI than controls but males did not. Gallstones were twice as common in those with diabetes. There was no association with heart disease. A third of elderly patients of both sexes had gallstones but most had not had surgery and gallstones were seldom a cause of death^[5].

Common bile duct (CBD) stones may occur in 3-14.7% of all patients for whom cholecystectomy is performed^[6].

Types of stone

• Bile contains cholesterol, bile pigments (from broken-down haemoglobin) and phospholipids. If the concentrations of these vary, different kinds of stones may be formed.
• Cholesterol stones (80% of all GB stones in the UK) are large, often solitary and radiolucent.
• Black pigment stones are small, friable, irregular and radiolucent:
  • Risk factors include haemolysis (eg, sickle cell anaemia, hereditary spherocytosis, thalassaemia) and cirrhosis.
• Mixed stones are faceted and are comprised of calcium salts, pigment and cholesterol. 10% are radiopaque.
• Brown pigment stones (<5% in the UK) form as a result of stasis and infection within the biliary system, usually in the presence of Escherichia coli and Klebsiella spp.

Presentation in primary care

• Up to 70% of patients with gallstones are asymptomatic at the time of diagnosis. The number of patients with progression of asymptomatic to symptomatic disease is relatively low, ranging from 10-25%^[7].
• Gallstones may cause acute or chronic cholecystitis, biliary colic, pancreatitis or obstructive jaundice.
• Biliary colic is the most common presentation, caused by a gallstone impacting in the cystic duct or the ampulla of Vater.
• The second most common presentation is acute cholecystitis, caused by distension of the GB with subsequent necrosis and ischaemia of the mucosal wall.

Biliary colic

• The pain starts suddenly in the epigastrium or right upper quadrant (RUQ) and may radiate around to the back in the interscapular region.
• Contrary to its name, it often does not fluctuate but persists from 15 minutes up to 24 hours, subsiding spontaneously or with analgesics.
• Nausea or vomiting often accompanies the pain, which is visceral in origin and occurs as a result of distension of the gallbladder due to an obstruction or to the passage of a stone through the cystic duct.

Differential diagnosis

Vague abdominal discomfort, distension, nausea, flatulence and intolerance of fats may also be caused by reflux, peptic ulcers, irritable bowel syndrome, relapsing pancreatitis and tumours – eg, stomach, pancreas, colon or gallbladder. Two or more of these conditions may overlap, so the diagnosis may not be easy.

Investigations

• Urinalysis, CXR and ECG may help exclude other diseases.
• Ultrasound Is the best way to demonstrate stones, being 90-95% sensitive^[8]:
  • Sometimes stones are not mobile, in which case they are not easy to differentiate from unimportant polyps and very small ones may be missed or fail to throw a helpful acoustic shadow.
  • Ultrasonography can also allow measurement of the diameter of the CBD and show the liver and hepatic bile ducts but it can only identify with certainty about half of any stones in the CBD.
  • If the ultrasound scan findings are negative but there is a high level of suspicion, such as in a patient with upper abdominal pain and abnormal LFTs, it is worth repeating the investigation after an interval. This may pick up stones which were previously missed.
• Fuller evaluation is needed if abnormal LFTs or jaundice persist, in patients with acute pancreatitis and when the CBD is noticeably dilated.
• Endoscopic retrograde cholangiopancreatography (ERCP) may be used for the diagnosis of CBD stones and has also evolved from a diagnostic to a therapeutic procedure for the removal of CBD stones^[9].
• Computerised tomography (CT) may be useful when filling the bile duct is unsuccessful in ERCP or when the procedure cannot be used for other reasons.
• Other techniques which may be used include magnetic resonance cholangiopancreatography and endoscopic ultrasonography^[8].

Cholecystitis

^[10]

Risk factors

• Gallstones or biliary sludge (95% of patients).
• Hospitalisation for trauma or acute biliary illness (this represents the other 5%, without gallstones).
• Female gender.
• Increasing age.
• Obesity.
• Rapid weight loss.
• Pregnancy.
• Crohn’s disease.
• Hyperlipidaemia.

Presentation

This follows impaction of a stone in the cystic duct, which may cause continuous epigastric or RUQ pain, vomiting, fever, local peritonism, or a GB mass.

• The main difference from biliary colic is the inflammatory component (local peritonism, fever, raised white cell count (WCC)).
• If the stone moves to the CBD, jaundice may occur.
• Murphy’s sign: lay two fingers over the RUQ. Ask the patient to breathe in. This causes pain and arrest of inspiration as the inflamed GB impinges on your fingers. The sign is only positive if a similar manoeuvre in the left upper quadrant does not cause pain.
• Repeated attacks of acute cholecystitis lead to chronic cholecystitis, in which the walls of the GB become thickened and scarred and the GB becomes shrivelled.

Investigations

• FBC – the WCC is likely to be raised.
• Liver enzymes are often mildly abnormal.
• Ultrasound findings for cholecystitis:
  • Include a thickened GB wall (greater than 3 mm) and may also include pericholecystic fluid or air in the GB or the GB wall.
  • If the GB wall is thickened but there are no gallstones present then the diagnosis could still be acalculous cholecystitis.
• Hydroxyiminodiacetic acid (HIDA) cholescintigraphy may be used to reveal a blocked cystic duct.

This occurs when an obstructed CBD becomes contaminated with bacteria. In severe cases, symptoms can include pain in the RUQ, jaundice and high swinging fevers with rigors and chills (Charcot’s triad).

Obstructive jaundice

See the separate Jaundice article.

Other presentations

Cholangitis

See the separate Cholangitis article.

Pancreatitis

See the separate Acute Pancreatitis and Chronic Pancreatitis articles.

Passage of the gallstone into the bowel causes a temporary blockage of the biliopancreatic duct, leading to a premature release of pancreatic enzymes. Symptoms include persistent epigastric pain radiating to the back which is relieved by leaning forwards and profuse vomiting. One study found that a serum total bilirubin level of or greater than 68.4 μmol/L on hospital Day 2 predicted persisting CBD stones with enough specificity to serve as a practical guideline for ERCP while minimising unnecessary procedures^[11].

Empyema

The obstructed GB fills with pus. The patient may become quite toxic and there is a marked fever and leukocytosis.

Gallstone ileus

Gallstone ileus is caused by occlusion of the intestinal lumen as a result of one or more gallstones. It is a rare complication of gallstones that occurs in 1-4% of all cases of bowel obstruction. The mortality is 12-27%^[12].

The management of gallstones, biliary colic and cholecystitis

^{[1, 13]}

Many patients can be managed initially at home. Factors to be taken into account include the age of the patient, social support and the severity of symptoms.

Non-surgical

• Biliary colic and acute cholecystitis – these are conditions which will usually respond to an opioid such as morphine or pethidine given parenterally and/or diclofenac by suppository. These routes will overcome difficulties in absorption caused by vomiting. Pain continuing for over 24 hours or accompanied by fever usually necessitates hospital admission.
• It is generally considered that patients who require antibiotics should have them intravenously in hospital. There is no evidence base to support the use of oral antibiotics at home, except where the patient has been discharged from hospital after a course of intravenous antibiotics but without having had surgical removal of the stones. One study also supported current guidelines that antibiotics before elective cholecystectomy were unnecessary^[14].
• Chronic cholecystitis – the same principles apply to acute attacks of pain in patients with chronic cholecystitis.

Surgical

• Early cholecystectomy (to be carried out within one week of diagnosis) is recommended by the National Institute for Health and Care Excellence (NICE) for people with acute cholecystitis^[13]. A controlled cohort study found that such a target was feasible using a surgeon-led collaborative strategy^[15].
• Laparoscopic cholecystectomy is the preferred procedure. A Cochrane review found that there was no difference in mortality, postoperative complications, or operative time compared with open cholecystectomy. However, hospital stay was shorter and recovery time was quicker^[16]. An American study subsequently found that open cholecystectomy is associated with a higher mortality burden^[17].
• Day case surgery has been shown by studies to be as safe and as acceptable to patients as ‘overnight stay’ surgery and is more cost-effective^[18].
• Percutaneous cholecystotomy (surgical drainage of the GB) is useful for patients who are unfit for cholecystectomy.
• Natural orifice transluminal endoscopic surgery (NOTES) has been developed. The peritoneal cavity is accessed via a natural orifice such as the mouth, rectum or vagina. Cholecystectomy via a gastroscope without laparascopic guidance has been reported^[19].

Editor’s note

Dr Sarah Jarvis, 6th July 2021

Laser lithotripsy for difficult-to-treat bile duct stones
NICE has issued a technological appraisal guidance on the use of laser lithotripsy as an option for the management of difficult-to-treat bile duct stones^[20]. The procedure, usually carried out under general anaesthetic, involves the passage of an endoscope, inserted orally (or sometimes percutaneously), into the biliary tract.  Once the tip of the fibre is in direct contact with the stone, a laser is focused on its surface to create a plasma bubble. This oscillates and induces cavitation with compressive waves to fragment the stone.

While the committee concludes that evidence on the efficacy of this procedure is adequate, evidence on its long-term safety is limited in quantity. They therefore recommend that the procedure should only be used with special arrangements for clinical governance, consent, and audit or research. 

Risks of surgery

• Postoperative complications are rare but do occur. The most significant is injury to the bile duct which occurs at a rate of 0.2% in both open and laparoscopic surgery.
• Fat intolerance may develop in a small proportion of patients – and a low-fat diet is recommended. However, evidence to support the usefulness of this diet is weak^[2].
• Post-cholecystectomy syndrome refers to to heterogeneous group of symptoms and findings in patients who have undergone cholecystectomy. It’s a rare situation; these patients can present with abdominal pain, jaundice or dyspeptic symptoms^[21].

The management of silent stones

^[22]

Patients should be managed on a case-by-case basis. 1-4% of asymptomatic patients develop problems related to gallstones annually, so the odds are in favour of a ‘watch and wait’ policy. Younger patients tend to develop complications more frequently because they have a longer time for the gallstones to cause problems and smaller stones cause more problems than larger ones, as they are more likely to become dislodged.

The management of bile duct stones

^[23]

Consensus guidelines were commissioned by the British Society of Gastroenterology (BSG) in 2008 and updated in 2016.

The most recent guideline suggests:

• Cholecystectomy and exploration of the CBD if the GB is present, preferably through a laparoscope.
• Biliary sphincterotomy and endoscopic stone extraction if the GB has been previously removed.
• Consider a biliary stent if stones are irretrievable (may be definitive treatment if the patient is unfit for surgery).
• Laparoscopic duct exploration and ERCP (supplemented by endoscopic papillary balloon dilatation (EPBD) with prior sphincterotomy, mechanical lithotripsy or cholangioscopy where necessary) should be considered in difficult cases. Percutaneous stone extraction and open surgery should be used as a last resort.

There appears to be a range of practice with respect to the use of endoscopic surgery in the management of CBD stones. Despite the guidance from the BSG, a Cochrane review found that open bile duct surgery seemed superior to ERCP in clearing CBD stones. There was no significant difference in the mortality and morbidity between laparoscopic bile duct clearance and the endoscopic options. There was no significant reduction in the number of retained stones and failure rates in the laparoscopy groups compared with the pre-operative and intra-operative ERCP groups^[24].

The management of other gallstone problems

• Cholangitis: medical treatment includes broad-spectrum intravenous antibiotics and correction of fluid/electrolyte disturbance. Surgical decompression of the GB may be required. Endoscopic drainage has replaced emergency surgical common duct exploration and T-tube drainage in patients with severe cholangitis. Percutaneous transhepatic biliary drainage (PTBD) is another option.
• Empyema: intravenous antibiotics are combined with urgent decompression and removal of the GB. Decompression may be carried out via a laparoscope under radiological guidance prior to GB resection, as this makes the GB easier to handle. The conversion to open cholecystectomy is 40-80% but complications are no higher with laparoscopic removal than with open surgery. One study suggested that conversion rates are proportional to the experience of the surgeon^[25].
• Gallstone ileus: treatment is traditionally by laparotomy and ‘milking’ the obstructing stone into the colon or by enterotomy and extraction. Recently, laparoscopic techniques have been used.

Prevention

• Ursodeoxycholic acid is useful in preventing high-risk patients (eg, morbidly obese patients undergoing rapid weight loss following bariatric surgery) from developing gallstones^[26]. However, studies suggest that ursodeoxycholic acid has no effect on the reduction of biliary symptoms, once the stones have formed^[22].
• It is suggested that a healthy lifestyle, regular physical activity and the maintenance of an ideal body weight might prevent cholesterol stones and symptomatic gallstones – but the evidence here is weak^[27].

Gallbladder Disorders & Treatment | Summa Health Digestive Program

The gallbladder is a pear-shaped sac found just below the liver that is the “holding area” for bile. Bile is produced by the liver to help digest foods. The gallbladder releases the bile into the small intestine to help break down food, particularly fatty foods.

Usually, the gallbladder is not the subject of a health concern. However, if something slows the flow of bile or blocks it completely, then problems can occur. 

The presence of other (co-morbid) conditions may also cause gallbladder concerns, including:

• Obesity
• Childbirth
• Gender-related (female) conditions
• Consumption of fatty foods

Common gallbladder disorders include:

• Biliary colic. A term for severe episodes of pain caused by gallstone blockage of the cystic duct. The blockage causes the gallbladder to contract vigorously, causing spasmodic (or sometimes constant) severe pain. Episodes usually last only an hour or two, and may recur infrequently, often years apart.
• Dysfunctional gallbladder or chronic gallbladder disease. The gallbladder becomes scarred from the gallstones and the repeated episodes of inflammation.
• Gallstones (cholelithiasis). Stones develop inside the gallbladder and can cause pain. However, about 90% of patients suffering with gallstones may have no symptoms, and may have had the stones present for a number of years. Studies indicate that if a patient has gallstones present for 10 or more years, they are less likely to cause symptoms.
• Inflamed gallbladder (cholecystitis). Inflammation of the gallbladder can be caused by gallstones – the most common cause – excessive alcohol use, infections, or even tumors that cause bile buildup. The gallbladder may rupture, which is cause for a surgical emergency.
• Sclerosing cholangitis. A disease of the bile ducts that causes inflammation of the liver, slowing the flow of bile to the gut. This can lead to cirrhosis of the liver, liver failure or even liver cancer.

Signs and symptoms of gallbladder disorders

The symptoms of a gallbladder disorder can vary depending on the type of condition. However, most symptoms start with pain in the upper abdominal area, either in the upper right or middle. Other common symptoms include:

• Chest pain
• Chills
• Clay-colored stool
• Feeling of fullness
• Heartburn, indigestion, and excessive gas
• Jaundice (yellowing of the skin and eyes)
• Pain that extends below the right shoulder blade or to the back; that worsens after eating a meal, particularly fatty or greasy foods; or a pain that increases when you breathe in deeply
• Tenderness in the abdomen, particularly the right upper quadrant
• Vomiting, nausea, fever

Diagnosis of gallbladder disorders

The first step in the diagnosis of a gallbladder disorder is to pinpoint the actual cause of the patient’s discomfort. Typically, a process of elimination is used to rule out any other disorders which might be mimicking a gallbladder attack, such as:

• Acute appendicitis
• Diverticulosis/Diverticulitis
• Gastroesophageal Reflux Disease (GERD)
• Heart attack. Often mistaken as a gallbladder attack.
• Hiatal hernia
• Inflammatory Bowel Disease (Crohn’s disease)
• Irritable Bowel Syndrome
• Kidney stones
• Pancreatitis
• Pneumonia
• Pregnancy complications
• Stomach ulcers
• Ulcerative colitis
• Urinary tract infections
• Viral hepatitis

Your doctor will first conduct a complete medical history and physical examination. Diagnostic tests will be then be used to determine if the abdominal pain is caused solely by gallstones or another condition – one or more of the following techniques may be used:

• Abdominal X-ray
• Blood tests
• A computed tomography (CT) scan of the abdominal organs
• Endoscopic retrograde cholangiopancreatography (ERCP). A tube is placed down the throat, into the stomach, then into the small intestine. Dye is injected and the ducts of the gallbladder can be seen on X-ray.
• Endoscopic Ultrasound (EUS) – a specialized ultrasound probe placed on an endoscope which is used to image the gallbladder and biliary duct.
• HIDA scan. A radioactive material called hydroxy iminodiacetic acid (HIDA) is injected and is taken up by the gallbladder to measure gallbladder emptying function. This test also is referred to as cholescintigraphy.

Treatment of gallbladder disorders

Gallstones are typically managed through medical observation or removal of the gallbladder (cholecystectomy). Less commonly used treatments include sphincterotomy and extraction of gallstones or dissolving gallstones with oral medications.

Your gastroenterologist may also recommend a change in diet for the management of gallstones: 

• Coffee. Drinking coffee every day can lower the risk of gallstones; the caffeine is thought to stimulate gallbladder contractions and lower the cholesterol concentrations in bile.
• Fats. Although fats (particularly saturated fats found in meats, butter, and other animal products) have been associated with gallstone attacks, some studies have found a lower risk for gallstones in people who consume foods containing monounsaturated fats (found in olive and canola oils) or omega-3 fatty acids (found in canola, flaxseed, and fish oil). Fish oil may be particularly beneficial in patients with high triglyceride levels, because it improves the emptying actions of the gallbladder.
• Fiber. High intake of fiber has been associated with a lower risk for gallstones.
• Fruits and Vegetables. Studies have indicated that patients who consume a lot of fruits and vegetables may have a lower risk of developing gallstones that require gallbladder removal.
• High carbohydrates. Diets that are high in carbohydrates (such as pasta and bread) can also increase risk; carbohydrates are converted to sugar in the body.
• Nuts. Studies suggest that people may be able to reduce their risk of gallstones by eating more nuts (peanuts and tree nuts, such as walnuts and almonds).
• Sugar. High intake of sugar can increase the risk for gallstones.

As a comprehensive treatment measure for emergency cases or more serious gallbladder disorders, surgery may be required. Summa surgeons perform many gallbladder procedures including a Cholecystectomy, which is removal of the gallbladder using a minimally invasive approach, an open surgical approach or minimally-invasive, robotic-assisted surgery instead of a scope.

To schedule an appointment with a Summa physician to discuss treatment for your gastrointestinal condition, click or call 330.761.1111.

Advanced gallbladder inflammation is a risk factor for gallbladder perforation in patients with acute cholecystitis | World Journal of Emergency Surgery

This study investigated the extent of gallbladder inflammation in patients undergoing emergency or urgent surgery for APC. Fifty patients with confirmed APC following intraoperative and histological diagnosis were compared to 150 randomly chosen cases undergoing LC for AC without perforation. Advanced gallbladder inflammation with empyematous and gangrenous cholecystitis was recorded significantly more often in the APC group compared to the control. Patients with APC were significantly older and had significantly higher CRP in comparison to the controls. Surgery lasted significantly longer; the rates of conversation, morbidity, and mortality were significantly higher in the APC group. ICU management was needed significantly more often in the APC group, and the overall LOS was significantly longer in the APC group compared to the group without perforation.

Gallbladder perforation in the setting of acute cholecystitis has been suggested in our recently published register study to be a risk factor for poor outcome in patients undergoing cholecystectomy for AC [1]. The outcomes of 5704 cases with APC undergoing emergency or urgent cholecystectomy were compared to those of 39,661 patients without perforation. The duration of surgery, the rates of conversation, morbidity, and mortality were significantly higher in patients with APC compared to those without APC. The results of the present study are in accordance with the results reported in the above study.

A great drawback to the register study by Jansen et al. which was clearly stated by the authors in the limitation section was the inability to characterize the extent of gallbladder inflammation because the register data used in their study did not contain histology findings. This shortcoming was investigated in the present study. Complicated cholecystitis defined as advanced gallbladder inflammation in the form of empyematous or gangrenous cholecystitis was confirmed in a significant portion of the APC group compared to the control group.

Advanced age > 65 years and elevated CRP were identified as risk factors for APC. These factors were further confirmed on multivariate analysis as independent risk factors for APC. These same factors have been previously described in connection with other forms of severe cholecystitis and therefore are not specific for APC [18, 19].

The significantly longer duration of surgery and higher rate of conversion to open surgery following attempted LC in the APC group in comparison to the group without perforation are de facto arguments for the surgical challenge associated with the management of patients with APC. Besides, the 8% rate of bile duct injury and 6% rate of postoperative intra-abdominal abscess formation in the APC group herald the severity of this entity. The mortality rate in this study was 8%. This rate is almost twice the reported rate by Jansen et al. [1] but comparable with the 9.5% rate of death reported in a retrospective analysis of 137 patients with APC by Ausania et al. in 2015 [20]. The heterogeneity in the reported risk of mortality in this and as well as in previous publications must be interpreted in context with the study population. Furthermore, the significantly higher rates of ICU management, as well as the significantly longer LOS, must be interpreted as indicators of the astringent nature of APC.

Another interesting finding in this study was the fact that four patients (8%) in the APC group underwent primary open cholecystectomy compared to none in the control group. These patients underwent explorative laparotomy for acute abdomen with peritonitis, and the diagnosis of APC was reached during surgery. Type I perforation with bilious peritonitis was evident during laparotomy in these patients. This finding should be interpreted as a further demonstration of the severe clinical nature of APC.

The retrospective study design and the small size of the study population must be stated as possible limitations to this study. Thus, further investigations with larger populations would be needed to further investigate the trends shown here. Besides, the results reported in this study might be secondary to the profound expertise in laparoscopic surgery in our department. Therefore, the results of this study might not be readily projected on other institutions. All cases included in this study were managed surgically. Interventional treatment like percutaneous cholecystostomy is not routinely performed in our center. Although the current literature on the role of percutaneous cholecystostomy is not conclusive [21,22,23,24,25], it remains speculative if the outcomes recorded in this study might have been altered by such an interventional management.

Surgeons and clinicians must be aware of the severe nature of APC with associated high risks of morbidity and mortality. The surgical management of such patients warrants profound expertise, and conversion from laparoscopic to open surgery should never be considered a failure. A vigilant postoperative care including the use of broadband antibiotics and close monitoring, e.g., in the ICU, should be considered in such cases.

Taken together, the results of this study confirm APC as a severe complication of AC with significantly higher rates of morbidity and mortality. Advanced gallbladder inflammation including empyematous and gangrenous cholecystitis was seen significantly more often in patients with APC compared to those without perforation. Thus, gallbladder perforation in APC must be secondary to advanced gallbladder inflammation.

Treatment of diseases of the gallbladder and its ducts

Diseases of the gallbladder , the symptoms of which will be described below, are pathologies of the digestive organ, which somewhat resembles a small hollow pear in appearance. The gallbladder is located above the liver. The gallbladder is connected to the liver using special tubes called bile ducts. They accumulate and remove bile. This is the main function performed by the bile duct and its ducts. Bile, which is produced in the liver, has the function of improving the absorption of lipids, and also activates the movement of food consumed through the intestines.In 24 hours, about 2 liters of bile are produced in the human liver.

Diseases of the gallbladder: causes and treatment

Both the inner walls of the bile duct and the walls of its ducts are a layer of muscles, which, by contracting, makes the bile move. If the contractions occur on time and smoothly, then bile is excreted in a timely manner. If, for some reason, a failure occurs in the bile duct, then dyskinesia begins (the mobility of the bile ducts and excretory tracts is impaired).By itself, this disease is not too dangerous, however, with chronic dyskinesia, cholelithiasis may develop.

Gallstone disease is a disease that is accompanied by the appearance of stones in the gallbladder, as well as in its ducts. Recently, this disease has been very common. It affects people who are overweight. Gallstone disease often occurs in adult women, after 40 years, than in men. In the case when the stones are in the gallbladder, then the person continues to live calmly, not even knowing that he is sick.But, if the stones for some reason begin to go out into the ducts, then an attack occurs called biliary colic.

With symptoms of gallbladder disease, treatment should not be delayed for a long time. If the stones came out through the ducts and ended up in the duodenum, then the person may have an unauthorized seizure. If the stones did not come out of the ducts and clogged them, then against this background a serious disease develops, which is called acute cholecystitis. This disease is very dangerous for human life, therefore, at the first symptoms of its occurrence, you should immediately go to the hospital.Not acute but chronic gallbladder disease is also a reason for treatment. Treatment of diseases of the gallbladder and its ducts is the work of a gastroenterologist. If the disease of the gallbladder cannot be treated without surgery, then you need to contact a surgeon.

At the Nadezhda medical center, every patient with gallbladder problems can undergo a diagnostic examination and treatment prescribed by a doctor.

90,000 What organs are affected by the coronavirus.The main thing about the pandemic from foreign media

As you know, the new coronavirus often causes pneumonia – pneumonia. But more and more evidence indicates that SARS-CoV-2 penetrates into other parts of the body. “Disease can attack almost anything in the body, and the consequences are devastating,” cardiologist Harlan Krumholz of Yale University told Science magazine.

• Doctors in Wuhan, China, have noticed that tens of percent of those hospitalized with COVID-19 have heart damage.In Italy, a woman was admitted to hospital with suspected heart attack, as indicated by a cardiogram, a blood test, and edema with scars on the heart. But her arteries were fine, but the coronavirus test was positive.
• With COVID-19, blood clotting is often disrupted – blood clots are formed. Torn off blood clots can clog arteries. If this occurs in the lungs, a pulmonary embolism develops, which has symptoms that resemble pneumonia and is often fatal. And if a blood clot enters the brain, then there will be a stroke.
• Infection can also lead to vasoconstriction. This would explain why patients have swollen and sore fingers. Also, narrowed vessels can be attributed to the fact that with a low level of oxygen in the blood, many patients breathe normally, although in theory they should suffocate: it’s just not about the lungs filled with fluid. Finally, vascular damage makes it clear why diabetics and hypertensive patients are more likely to have complications: their vessels were not in the best shape even before infection.
• Chinese doctors noticed blood and protein in the urine of patients – this indicates kidney damage.Many have kidney failure altogether. One study found that those with severe damage to this paired organ were more than five times more likely to die from COVID-19.
• Some patients with COVID-19 have seizures, encephalitis, others lose consciousness, taste and smell. This suggests that the virus can also attack the brain. Doctors interviewed by Science admit that an infection spread to the brain can disrupt the reflex in response to oxygen deprivation: therefore, patients do not suffocate.
• Sometimes the infected develop diarrhea, vomiting.RNA of the virus is found in feces, and Chinese scientists have found residues of SARS-CoV-2 in samples from different parts of the gastrointestinal tract. From this it can be assumed that feces are contagious, but there is no evidence of this.
• Even in hospital patients, conjunctivitis, liver damage, and gallbladder damage are often found. It’s unclear if the virus is to blame. Experts questioned by Science have doubts about the liver and gallbladder.

However, there is no complete certainty with other authorities either.SARS-CoV-2 enters cells with a surface protein called ACE2, which regulates blood pressure. Roughly speaking, the virus resembles a burdock, which sticks to the villi of tissue, but does not cling to rubber. Cells with ACE2 are found in the nasopharynx – the infection begins with it – and in the lungs, but also in the heart, blood vessels, cortex and brain stem, gastrointestinal tract.

Even if traces of a virus are found in an organ or tissue, this does not mean that the damage is caused precisely by them.Perhaps it’s a cytokine storm. Cytokines are molecules involved in the immune response. When the level of some of them jumps, the immune system, as if breaking off the chain, attacks both friends and foes – severe inflammation begins. Some doctors and scientists even suggest treating patients with drugs that suppress the immune system. But others fear it will help the virus.

It is possible that some organs suffer not from the virus itself and not from the immune response, but from a lack of oxygen.Or the virus changes hormone levels. Or therapy is both beneficial and harmful. Or something else. Or all at once. But the more we learn about SARS-CoV-2 and the disease it causes, the stronger the hope that the pandemic can be tackled.

Challenges in vaccine development

Biologist Robert Bazell spoke with other scientists to write for the Nautilus website about vaccines that could prevent COVID-19.

Vaccine developers aim at the same place – a protein on the surface of viral particles.This protein gives SARS-CoV-2 similarity to the corona, and most importantly, it has a site that allows the virus to adhere to the ACE2 protein in human cells. If you train the immune system with the help of a vaccine, then it will develop antibodies to this protein and, when it encounters a virus, will be able to quickly neutralize it. In theory.

There are several problems:

• Although antibodies generally protect against viruses, this has not been proven to be the case with SARS-CoV-2.
• Head of the Human Vaccines ProjectTASS) Wayne Koff believes that there is a 6-10% chance for a candidate vaccine that it will pass all stages of testing and be approved. One vaccine development costs from $ 1 billion
• At best, the vaccine will be ready in 18 months. It is not known where the pandemic will go by this time.
• Billions of doses will probably be required. If each person needs not one, but, say, three injections, then the required number of doses will increase by several billion more.
• Wayne Coff fears that the vaccine could elicit an oversized immune response (a problem faced by several vaccine developers against SARS-CoV-1, a related virus that caused the outbreak of SARS in 2002-2004; a safe and effective vaccine against SARS-CoV- 1 never appeared – approx.TASS). Validation will require large clinical trials, which will slow down the vaccine’s emergence.
• Due to the virus, blood clots appear in the vessels – the same can be triggered by the vaccine.
• It is unclear from whom to recruit volunteers for clinical trials.
• The vaccine must be effective not only for young people in rich countries, but also for old people and people from developing countries.
• Mutations can reduce the effectiveness of the vaccine. True, so far the site by which viral particles cling to cells has hardly changed.

There are different approaches to vaccine development. It would be good if several candidate vaccines emerge within each approach, because it is impossible to know in advance which one will be successful. Experts interviewed by the author of Nautilus agree that success depends on international cooperation never seen before.

Female hormones against COVID-19

While there is no vaccine (and there is no cure), doctors are trying existing remedies, sometimes unexpected: in the United States, they are trying to raise COVID-19 patients to their feet with female hormones, writes The New York Times.The idea is simple. It has been noticed that in all countries men are more likely than women to get seriously ill and die. The hormones estrogens and progesterone are also known to affect the immune system.

A doctor at a Los Angeles hospital where men are going to be treated with the hormone progesterone told The New York Times that only a quarter of patients in intensive care units are women. They also noticed that in pregnant women, the disease usually proceeds easily, although their immune system is suppressed (otherwise the body could reject the fetus – approx.TASS).

But it’s too early to rejoice. Women die from COVID-19 less often than men at any age, even when hormones almost stop being produced. Perhaps it’s not hormones, or just them. For example, men smoke more often and wash their hands less often, and both are risk factors. In addition, hormones are not the only factors behind the difference in the functioning of the immune systems of men and women.

Two studies will be conducted in the United States. The first will be attended by both men and women over 55 years old. They will be tested for estrogens.For the second, only men will be recruited, they will be given progesterone. Both hormones are considered safe, especially when taken for a short time. True, men can experience unusual sensations such as hot flashes and soreness of the mammary glands.

Prepared by Marat Kuzaev

90,000 Cholecystitis: How to “Catch” and Treat Gallbladder Inflammation | Healthy life | Health

Our expert – Doctor of Medical Sciences, Professor of Moscow State University of Medicine and Dentistry Tatyana Polunina .

Turning moment

Inflammation of the gallbladder wall – chronic cholecystitis – usually develops gradually. Often it occurs against the background of other chronic diseases of the gastrointestinal tract: gastritis, pancreatitis, hepatitis.

The cause of cholecystitis is stagnation of bile in the gallbladder, to which an infection is added. Why does the gallbladder stop emptying as it should? There are many reasons. In a healthy body, the movement of bile is ensured by a good tone of the bile ducts, their correct nervous and endocrine regulation.This movement is hampered if the ducts are somehow compressed or bent, if their ability to move bile in the right direction has been impaired. This can happen under the influence of stress, disorders of endocrine and autonomic regulation. Often, the impetus for stagnation of bile is the prolapse of the viscera, pregnancy, a sedentary lifestyle, and rare meals.

Stagnation promotes the development of infection in the gallbladder. It can be bacteria – Escherichia coli, streptococci, staphylococci, as well as lamblia and fungi, hepatitis viruses.In some cases, inflammation is stimulated by toxic poisoning (for example, drug overdose) or an allergic process. Inflammatory processes in other organs, such as tonsillitis, also contribute to it.

Now constipation, then belching

Overeating is often the direct trigger for the outbreak of the inflammatory process in the gallbladder. A hearty lunch or dinner with fatty and spicy food, supplemented with beer or wine, may result in a dull, aching pain on the right, under the ribs.It occurs 1-3 hours after the banquet. The pain usually radiates upward, to the area of ​​the right shoulder and neck, right shoulder blade. Sharp pain may also occur, resembling biliary colic. In the mouth, the sensation of bitterness does not pass, a metallic taste, there may be belching, nausea, seething in the abdomen. Often there is an alternation of constipation and diarrhea, irritability, insomnia. Pressure on the abdomen in the gallbladder area is very sensitive, sometimes painful. Muscle resistance of the abdominal wall can be felt.

All these are signs of acute cholecystitis, which, if not taken action, can turn into chronic.The diagnosis can only be made by a doctor – after a blood test, duodenal intubation, microscopic examination of bile is carried out.

In some cases, cholecystography is required – X-ray examination. This is necessary to assess the shape and structure of the walls of the gallbladder, its contraction, the presence or absence of stones in it. Ultrasound also provides useful information. If cholecystitis has become chronic, an ultrasound scan shows a thickening or deformation of the walls of the gallbladder.

Prevent relapse

Cholecystitis in most cases has a long course. The periods of remission, when the patient practically does not notice his illness, are replaced by exacerbations, usually with a malnutrition and after taking alcoholic beverages. Hard physical work, acute intestinal infection, hypothermia can also become an impetus for a new exacerbation. However, if you follow the doctor’s recommendations, the prognosis is favorable in most cases.

Unfortunately, often patients come to the doctor too late – they simply do not pay attention to the first attack, cope with it with the help of home remedies on the advice of friends and neighbors, and then, when the pain has passed, they do not change anything in their lifestyle.With frequent relapses, inflammation of the large intrahepatic ducts may develop. At the same time, an increase in body temperature, sometimes chills, fever, and itching are added to the pain. The skin and mucous membrane of the eyes may turn yellow, which is associated with a deterioration in the outflow of bile due to blockage of the bile ducts with mucus.

In an acute condition, patients are usually hospitalized in surgical or therapeutic hospitals. In mild cases, outpatient treatment is possible. In the early days, it is necessary to strictly adhere to bed rest and diet No. 5a.Fractional food intake is very important – 4-6 times a day. The patient is prescribed selective antispasmodics, with an exacerbation – antibacterial drugs. After remission occurs, choleretic agents are recommended.

Diet

To stop the development of acute cholecystitis into chronic, and chronic – into cholelithiasis, you need to radically change your lifestyle and, above all, your diet. Doctors recommend dietary table number 5 or diet number 5 according to Pevzner.

Not allowed

• Fatty meat
• Animal Fat
• Spicy snacks
• Marinades
• Alcohol
• Ice Cream
• Chilled drinks
• Salted
• Fried
• Cakes, cream,
• Fish and mushroom broths
• Smoked products

Can

• Pureed vegetables
• Meat, minced, steamed or boiled
• Cottage cheese, kefir
• Tea, not strong, with milk
• Lactic acid products
• Butter, limited amount
• Vegetable oil – 20-30 g per day
• Protein omelet, soft-boiled eggs – 1-2 times a week
• Vegetarian borscht, cabbage soup
• Soups cereal, fruit, dairy
• Boiled and baked vegetables
• Any porridge
• Pasta, noodles
• Baked cheese cakes
• Vegetable and fruit juices
• Lean meat (beef, chicken, turkey, rabbit), cooked, baked
• Compotes, jelly, rosehip decoction
• Dry biscuits
• Fruits and berries (except sour), raw and cooked, grapes
• Stale bread: white, gray
• Watermelon
• Boiled low-fat fish
• Cheese, not spicy

► It is necessary to eat with such a diet 5 times a day, in small portions.This diet is prescribed to ensure a gentle regime of the liver, normalization of bile secretion and intestinal activity, unloading of fat and cholesterol metabolism.

► Beef, lamb and pork fat, lard, liver, brains, sausage, canned fish and meat, pickles, meat, fish broths, and pastry should be completely excluded. If possible, you should limit the use of butter, eggs, garlic, onions, dill and parsley. It is also recommended to eat cottage cheese, vegetables and fruits.Fluids should be consumed abundantly, but the condition of the cardiovascular system and kidneys should be taken into account. The consumption of table salt should be moderately reduced.

Chemical composition of the diet:

• Protein approx. 100-110 g
• Fats 80-100 g
• Carbohydrates approx. 400-450 g
• The number of calories is 2800-3200.

► To improve the condition of the bile ducts, you need to lead a more active lifestyle, regularly arrange a warm-up during the working day, walk more, visit a sports club or a swimming pool.

► Be alert and with foci of chronic infection, if they are in the body: do not run bad teeth, sore throat, inflammation in the pelvic organs. If they are treated in a timely manner, you can avoid the next troubles with the gallbladder.

See also:

90,000 Medical centers Capital diagnostics in the Bryansk region

DIABETES is a chronic disease that develops when the pancreas does not produce enough insulin or when the body cannot efficiently use the insulin it produces.

Insulin is a hormone that regulates blood sugar levels.

By the way, this year marks the 100th anniversary of the discovery of insulin!

A common consequence of uncontrolled diabetes is hyperglycemia, or elevated blood sugar levels, which over time can severely damage many body systems, especially nerves and blood vessels.

TYPE 1 DIABETES
In type 1 diabetes (formerly insulin-dependent, juvenile or childhood), which is characterized by insufficient insulin production, the patient requires daily insulin administration.The cause of this type of diabetes is currently unknown and preventive measures have not been developed.

Symptoms include excessive urination (polyuria), thirst (polydipsia), constant hunger, weight loss, blurred vision and fatigue. These symptoms can appear suddenly.

TYPE 2 DIABETES
Type 2 diabetes (formerly non-insulin dependent or adult diabetes) develops as a result of ineffective use of insulin by the body. Most diabetics suffer from type 2 diabetes.This type of diabetes occurs mainly in the presence of overweight and insufficient physical activity.

Its symptoms may be similar to those of type 1 diabetes, but are often less severe. As a result, the disease is often diagnosed several years after its onset, after the onset of complications.

Until recently, this type of diabetes was observed only among adults, but now it is increasingly affecting children as well.

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post created on the basis of materials from the site www.who.int

# metropolitan diagnostics # cd_diabetes # diabetes # tuchkovo # ruza # gorodgagarin # klintsy # klimovo # novozybkov # unecha # starodub # pochep # trubchevsk # endocrinologist tuchkovo # endocrinologist-climatic # diabetes mellitus # endocrinologist endocrinologist # 9000

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Posthumous hero of the covid – Pioneer. – LJ