Where is the gallbladder located in the body. How do gallstones form and what are their symptoms. Who is at higher risk for gallbladder problems. What dietary changes can help prevent gallstones.

The Gallbladder: A Small Organ with a Big Role

The gallbladder is a small, pear-shaped organ located on the right side of the abdomen, just below the liver. Despite its modest size, this organ plays a crucial role in the digestive process. Its primary function is to store bile, a fluid produced by the liver that aids in the digestion of fats and certain vitamins.

When we consume food, particularly those containing fats, the gallbladder receives signals to contract and release bile into the small intestine through a network of ducts. This process helps break down fats and facilitates their absorption by the body.

The Composition of Bile

Bile is a complex fluid composed of various substances, including:

• Water
• Bile acids
• Cholesterol
• Bilirubin
• Electrolytes

The balance of these components is crucial for maintaining proper gallbladder function and preventing the formation of gallstones.

Gallstones: The Most Common Gallbladder Issue

Gallstones are the most prevalent gallbladder problem, affecting millions of people worldwide. These solid masses form when components of bile, particularly cholesterol, clump together and solidify. Gallstones can vary in size, ranging from tiny grains to structures as large as a golf ball.

Types of Gallstones

There are two main types of gallstones:

1. Cholesterol stones: These are the most common type, primarily composed of hardened cholesterol.
2. Pigment stones: Less common, these stones are made of bilirubin and are more prevalent in individuals with certain medical conditions like cirrhosis or sickle cell disease.

Why do some people develop gallstones while others don’t? The exact cause is not always clear, but several factors can increase the risk of stone formation.

Recognizing Gallbladder Problems: Symptoms and Diagnosis

When gallstones block the bile ducts, they can cause inflammation of the gallbladder, a condition known as cholecystitis. This can lead to a range of uncomfortable symptoms, including:

• Intense pain in the upper right abdomen
• Nausea and vomiting
• Pain that radiates to the back or right shoulder blade
• Discomfort that worsens with deep breaths

How do doctors diagnose gallbladder issues? The diagnostic process typically involves a combination of physical examination, blood tests, and imaging studies. Ultrasound is often the preferred imaging method, as it can create detailed images of the gallbladder using sound waves. In some cases, additional tests like X-rays or liver function tests may be necessary to confirm the diagnosis and assess the severity of the condition.

Risk Factors for Gallbladder Disease

Several factors can increase an individual’s likelihood of developing gallbladder problems, particularly gallstones. Understanding these risk factors can help in implementing preventive measures.

Genetic and Ethnic Factors

Genetics play a significant role in gallstone formation. If you have a family history of gallstones, your risk is higher. Certain ethnic groups, such as Mexican-Americans and Native Americans, have a higher prevalence of gallbladder disease. The Pima tribe of Arizona, for instance, has the highest rate of gallbladder disease in the world.

Gender and Hormonal Influences

Women are more susceptible to gallstones than men, largely due to the influence of estrogen. This female sex hormone can increase cholesterol levels in bile, promoting stone formation. Pregnancy also raises the risk, as it can lead to the accumulation of gallbladder sludge, a thick liquid that the body struggles to absorb.

Weight and Body Composition

Obesity is a significant risk factor for gallbladder disease. Excess weight can lead to increased cholesterol production and may result in a larger, less efficient gallbladder. Interestingly, the distribution of body fat also matters. Individuals who carry more weight around their waist (apple-shaped) are at higher risk compared to those with weight concentrated in the hips and thighs (pear-shaped).

The Impact of Diet and Weight Loss on Gallbladder Health

Diet plays a crucial role in gallbladder health, influencing both the risk of developing gallstones and the management of existing gallbladder issues.

Dietary Risk Factors

A diet high in cholesterol and fats can increase the likelihood of gallstone formation. Similarly, low fiber intake and consumption of refined carbohydrates (such as white bread and white rice) are associated with a higher risk of gallbladder problems.

The Weight Loss Paradox

While maintaining a healthy weight is generally beneficial for gallbladder health, rapid weight loss can paradoxically increase the risk of gallstones. Very low-calorie diets and weight loss surgeries can be particularly hard on the gallbladder. The safest approach is gradual weight loss, aiming for no more than 3 pounds per week.

Weight cycling, or yo-yo dieting, can also stress the gallbladder and increase the risk of stone formation. Consistent, sustainable weight management is key to long-term gallbladder health.

Medical Conditions and Medications Affecting Gallbladder Health

Certain medical conditions and medications can influence gallbladder function and increase the risk of complications.

Chronic Kidney Disease

Individuals with chronic kidney disease often have elevated levels of triglycerides in their blood, which can contribute to gallstone formation. Additionally, kidney disease may affect the gallbladder’s ability to respond to normal bodily signals, potentially leading to bile buildup.

Medications and Hormonal Therapies

Several medications can impact gallbladder health:

• Birth control pills and hormone replacement therapy: These can increase the risk of gallstones due to their estrogen content.
• Fibrates: Medications used to lower cholesterol may paradoxically increase cholesterol levels in bile, promoting stone formation.

It’s important to discuss the potential gallbladder-related side effects of any medications with a healthcare provider.

Preventing Gallbladder Problems: Lifestyle and Dietary Strategies

While some risk factors for gallbladder disease are beyond our control, there are several proactive steps individuals can take to maintain gallbladder health and reduce the risk of complications.

Dietary Recommendations

A gallbladder-friendly diet emphasizes:

• High-fiber foods: Fruits, vegetables, whole grains, and legumes
• Healthy fats: Olive oil, fish oil, and other sources of omega-3 fatty acids
• Lean proteins: Poultry, fish, and plant-based protein sources
• Limited refined carbohydrates: Choose whole wheat bread over white, and brown rice over white rice

Staying well-hydrated and maintaining regular meal times can also support gallbladder function.

Weight Management

Achieving and maintaining a healthy weight is crucial for gallbladder health. However, it’s important to approach weight loss gradually and sustainably. Crash diets and extreme calorie restriction can do more harm than good when it comes to gallbladder function.

Regular Exercise

Physical activity can help maintain a healthy weight and may improve overall digestive health. Aim for at least 150 minutes of moderate-intensity exercise per week, or 75 minutes of vigorous-intensity activity.

Limiting Alcohol and Quitting Smoking

Excessive alcohol consumption can increase the risk of gallstones and other gallbladder problems. Smoking has also been linked to an increased risk of gallbladder disease. Quitting smoking and moderating alcohol intake can have wide-ranging health benefits, including improved gallbladder function.

When to Seek Medical Attention for Gallbladder Issues

While many gallstones remain asymptomatic and don’t require treatment, it’s important to recognize when medical intervention is necessary. Severe or persistent symptoms may indicate a more serious condition that requires prompt attention.

Warning Signs

Seek medical care if you experience:

• Intense, persistent abdominal pain, especially in the upper right quadrant
• Fever and chills, which may indicate infection
• Jaundice (yellowing of the skin or eyes)
• Dark urine or light-colored stools
• Persistent nausea or vomiting

Treatment Options

For symptomatic gallstones or recurrent gallbladder issues, the most common treatment is cholecystectomy, a surgical procedure to remove the gallbladder. This operation is typically performed laparoscopically, resulting in smaller incisions and faster recovery times.

Can you live without a gallbladder? Yes, the body can function without this organ. After gallbladder removal, bile flows directly from the liver into the small intestine. While some individuals may experience minor digestive changes, most people adapt well to life without a gallbladder.

The Future of Gallbladder Health: Research and Emerging Treatments

As our understanding of gallbladder function and disease continues to evolve, researchers are exploring new avenues for prevention, diagnosis, and treatment of gallbladder issues.

Genetic Research

Advances in genetic studies are shedding light on the hereditary factors that influence gallstone formation. This research may lead to more personalized risk assessments and targeted preventive strategies in the future.

Non-Surgical Treatments

While surgery remains the gold standard for treating symptomatic gallstones, researchers are investigating non-invasive alternatives. These include:

• Lithotripsy: Using shock waves to break up gallstones
• Bile acid medications: Drugs that can dissolve small cholesterol stones over time
• Targeted therapies: Medications that could prevent stone formation or improve gallbladder function

Microbiome Research

Emerging evidence suggests that the gut microbiome may play a role in gallbladder health. Future treatments could involve probiotics or other interventions to promote a healthy balance of gut bacteria and reduce the risk of gallstone formation.

As research progresses, our approach to gallbladder health is likely to become more nuanced and personalized, offering hope for improved prevention and treatment options in the years to come.

Understanding the function of the gallbladder, recognizing the signs of gallbladder issues, and implementing preventive measures can go a long way in maintaining overall digestive health. By staying informed and making conscious lifestyle choices, individuals can take an active role in protecting this small but significant organ.

Visual Guide To Your Gallbladder

Medically Reviewed by Minesh Khatri, MD on August 22, 2021

Your gallbladder sits on the right side of your belly, below your liver. It’s a small organ, shaped like a pear, that holds a fluid called bile. This liquid, made in your liver, helps you digest fats and certain vitamins. When you eat, your body gets the signal to release it — through channels called ducts — into your small intestine.

The most common reason people have trouble with their gallbladder is gallstones. You get them when bile clumps together and forms solid masses. They can be as big as a golf ball, and you can have just one or several.

Most stones are made of hardened cholesterol. But people with certain conditions like cirrhosis and sickle cell disease are more likely to have another kind called pigment stones. These are made of bilirubin — a brownish yellow compound your liver makes when it breaks down old red blood cells.

If a gallstone gets into a duct and keeps bile from flowing out, your gallbladder can get inflamed. That’s called cholecystitis, and it can lead to nausea, vomiting, and belly pain. Bacteria also can cause it. You can tell you’re having gallbladder trouble by where it hurts: the upper right part of your belly. It might get worse when you take deep breaths, and you may also feel an ache in your back or right shoulder blade.

Your doctor will examine you and might want to take a sample of your blood to look for signs your body is fighting an infection. You probably will have an imaging test, like an ultrasound. It uses sound waves to make detailed images of your gallbladder. Your doctor also might want an X-ray of your belly or other blood tests to see how well your liver is working.

Some gallstones never cause problems and can be left alone — they’re called “silent.” But if you have symptoms, your doctor may recommend surgery, called cholecystectomy, to take out your gallbladder. You’ll be fine without it — the bile your liver makes will flow straight into your intestine.

Researchers believe estrogen plays a role in gallstones. The female sex hormone can boost the amount of cholesterol in your bile. And pregnancy can cause a buildup of something called gallbladder sludge, a thick liquid your body can’t absorb easily.

If someone in your family has had gallstones, your chances of getting them are higher. Mexican-Americans and Native Americans are more likely to have them than other people — the Pima tribe of Arizona has the highest rate of gallbladder disease in the world. Researchers think certain genes can raise the amount of cholesterol in bile.

If you’re overweight, your body may make more cholesterol, which means you’re more likely to have gallstones. You also may have a larger gallbladder that doesn’t work as well as it should. If you carry most of your weight around your waist rather than in your hips and thighs, that may also raise your chance of getting gallstones.

If you drop weight too quickly, you can be more likely to have gallstones, because weight loss surgeries and very low-calorie diets can be hard on your gallbladder. Cycling — losing and regaining weight over and over — also can cause trouble. The safest course is a slow one: Aim to shed fewer than 3 pounds a week.

Foods high in cholesterol and fat can raise your chances of gallstones. And you’re more likely to have gallbladder issues if you don’t have much fiber in your diet or you eat a lot of refined carbohydrates like white bread and white rice.

Birth control pills and hormone replacement therapy can raise your chances of gallstones because they have estrogen in them. Medicines called fibrates, which help lower your cholesterol, have been linked to gallbladder disease because they can raise the amount of cholesterol in your bile. 

If you have this condition that affects your kidneys, you may have more of a kind of fat called triglyceride in your blood, and that can boost your chances of gallstones. Researchers also think your gallbladder may not react to your body’s signals the way it should and that can let bile build up.

The risk of gallstones is higher once you’re past 40, but you can do a few things to help avoid them. Stay at a healthy weight, but don’t fast or go on crash diets. Eat plenty of fiber and good fats like olive and fish oil, and don’t eat much refined grain. Choose whole wheat instead of white bread, for example, and brown rice instead of white.

IMAGES PROVIDED BY:

1) PIXOLOGICSTUDIO/SCIENCE PHOTO LIBRARY / Getty Images

2) Scott Bodell / Medfical Images

3) George Chernilevsky / Wikipedia  (left), moonisblack / Thinkstock  (right)

4) BSIP / UIG / Getty Images

5) YakobchukOlena / Thinkstock

6) Dr P. Marazzi / Science Source

7) monkeybusinessimages / Thinkstock

8) Hero Images / Getty Images

9) ratikova / Thinkstock

10) wcphoto12 / Thinkstock

11) Wavebreakmedia Ltd / Thinkstock

12) crankyT / Thinkstock

13) AndreyPopov / Thinkstock

14) moodboard / Thinkstock

Mayo Clinic: “Diseases and Conditions — Gallstones.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Gallstones. “

Massachusetts General Hospital: “Conditions and Treatments — Cholecystitis. “

American College of Gastroenterology: “Gallstones in Women.”

National Institute of Diabetes and Digestive and Kidney Diseases: “Dieting and Gallstones.”

American Heart Association: “Cholesterol Medications.”

Arteriosclerosis, Thrombosis, and Vascular Biology, November 2001.

Drug Safety, January-February, 1992.

Nigerian Journal of Surgery, July-December, 2013.

Neuroendocrinology Letters, February-April, 2003.

National Institute of Diabetes and Digestive and Kidney Diseases: “Smoking and the Digestive System.”

Smokefree.gov by the National Cancer Institute: “Benefits of Quitting.”

United Kingdom National Health Service: “Gallbladder Removal.”

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Functional disorders of the gallbladder – Gornovosti.Ru

Little rebel

Diseases of the biliary system are the most common diseases of the abdominal organs. They now affect up to 20 percent of the adult population in developed countries, and these diseases are on the rise. Elena GRISCHENKO, professor of the Department of Therapy of the Federal University of Higher Education, Krasnoyarsk Medical University, , tells the story of gastroenterologist .

Among the diseases of the biliary system, there are functional disorders of the gallbladder and sphincter of Oddi, acalculous inflammatory cholecystitis and cholelithiasis. These conditions are one pathological process extended in time: first, there is a violation of the motility of the gallbladder – dyskinesia, then an inflammatory process joins – acalculous cholecystitis is formed, which eventually transforms into cholelithiasis

Functional disorders of the gallbladder are violations of the tone and motility of the biliary system. There are no organic changes in the biliary system, but it functions incorrectly: either the outflow of bile is too fast, or, conversely, the bile is not evacuated in time and stagnates in the gallbladder.

There are many reasons for the disorder. Most often, the regulatory system of bile outflow is disturbed: the sympathetic and parasympathetic nervous systems are unbalanced, to put it simply, this is a neurosis. Disorders in the endocrine system also lead to dysfunction. It is known that with obesity, diabetes mellitus, in women taking oral contraceptives, hypofunction of the biliary system often develops. Motility of the gallbladder can be affected by occupational hazards, medication, various diets, alcohol and tobacco.

With an increased outflow of bile, rather intense paroxysmal pains in the right hypochondrium, resembling colic, are noted. There is a lot of bile, it enhances intestinal motility – dyspeptic disorders begin, easier – diarrhea.

Stagnation of bile is characterized by a feeling of heaviness, fullness in the right hypochondrium, severe intestinal discomfort and frequent constipation.

Pain may be constant, moderate or intense. They disrupt the patient’s physical activity, force him to see a doctor. Especially if they interfere with sleep or are accompanied by nausea, and sometimes vomiting.

A functional disorder of the gallbladder is diagnosed when there are characteristic pains and laboratory and instrumental examination data that exclude the presence of an organic pathology in the biliary system, for example, stones or inflammation of the gallbladder. And also there are no functional disorders of other organs of the gastrointestinal tract that can mimic such pain. To do this, they take a clinical and biochemical blood test, do an ultrasound of the abdominal cavity and retroperitoneal space, conduct a microscopic examination of bile obtained during duodenal sounding or retrograde cholangiopancreatography.

Duodenal sounding. First, various stimuli are introduced into the body (for example, a warm solution of magnesia) to stimulate contractions of the gallbladder and relax the sphincter of the common bile duct, which leads to the release of bile into the duodenum. The released bile is collected through a probe inserted into the duodenum and examined in the laboratory.

Retrograde cholangiopancreatography is a method that combines endoscopy with simultaneous fluoroscopic examination.

The gold standard for diagnosing gallbladder dysfunction is dynamic cholescintigraphy, a method for studying the movement of bile in the body.

A functional disorder of the gallbladder is said if

— the level of liver enzymes, bilirubin, amylase/lipase in the biochemical blood test is normal;

— no inflammatory reaction was found in the studied bile;

– stones in the gallbladder were not found;

– the fraction of exile in cholescintigraphy is less than 40 percent, that is, the norm.

Stagnation of bile, even temporary, leads to the development of inflammatory changes in the gallbladder wall, and later – gallstone disease, so the correction of functional disorders of the biliary system is necessary.

Cholecystitis is an inflammation of the gallbladder. There are acute and chronic.

Acute cholecystitis is the most dangerous form of this disease. In most cases, it is accompanied by the formation of calculi (stones) in the gallbladder itself or its ducts. This disease is also called cholelithiasis or calculous cholecystitis.

The danger of calculous cholecystitis lies in the excessive accumulation of cholesterol, calcium salts and bilirubin in the gallbladder cavity. These components are first deposited on the walls of the bladder in the form of calcifications – small, flake-like deposits. But over time, deposits increase in size, interfering with the normal functioning of the body. It is not uncommon for stones to enter the bile ducts, where they create a serious obstacle to the outflow of bile from the bladder. All this leads first to a certain discomfort and heaviness in the abdomen, and then there is an acute intense pain in the right hypochondrium, nausea, vomiting, the temperature rises to 38 degrees, chills may appear. Often the inflammation of the gallbladder spreads to the surrounding tissues, leading to peritonitis. The course of calculous cholecystitis is acute, therefore, it requires urgent medical treatment, often surgery

Acute acalculous cholecystitis is rare, usually proceeds without complications and ends in recovery, sometimes it can become chronic.

Chronic acalculous cholecystitis. This is a chronic recurrent inflammation of the gallbladder wall, accompanied by a violation of its motor-tonic function.

Chronic cholecystitis is considered as a physicochemical stage of cholelithiasis, in which it is necessary to prescribe preventive therapy in order to prevent the formation of true stones.

Factors leading to the development of chronic cholecystitis can be divided into main and additional.

Main factors:

– infection: E. coli, cocci, sometimes other microbial factors;

– chronic diseases of the liver, pancreas, which often lead to failure or increased tone of the sphincter of Oddi;

– disorders of the intestinal microflora.

Additional factors include:

– functional disorders of the neuromuscular apparatus of the biliary system, as a rule, develop in chronic cholecystitis, lead to impaired outflow and stagnation of bile;

– congenital anomalies of the gallbladder;

– all kinds of stressful situations;

– sedentary lifestyle;

– irregular food intake and unbalanced diet, excessive consumption of food rich in animal fats: fatty meat, eggs, butter – which disrupts the normal composition of bile;

– hereditary factors;

– parasitic diseases: giardiasis, opisthorchiasis, ascariasis;

– atherosclerosis, hypertension lead to impaired blood supply to the biliary system;

– endocrine disorders: obesity, diabetes mellitus, menstrual dysfunction, irregular sexual life;

– allergic and immunological reactions.

All additional factors create conditions for the development of inflammation and prepare fertile ground for the introduction of microbial flora.

Reference:

The liver is the largest and most important gland in our body. Liver cells continuously produce bile up to one liter per day day and night. Bile is necessary for the digestion of food, mainly fats. From the liver, bile enters the common bile duct and is secreted into the duodenum (duodenum). The flow of bile from this duct into the duodenum is regulated by the sphincter of Oddi muscle, which is located at the exit of the duct into the duodenum. When there is no food in the duodenum, the sphincter is closed and bile cannot enter the duodenum. It flows from the main duct into the gallbladder. This is a reservoir of bile. It holds about 50 milliliters of bile, which can be stored in it for a long time and then becomes more concentrated, since some of the water is absorbed from the bile. When, after a meal, the food mass from the stomach enters the duodenum, the sphincter of Oddi expands and bile from the common bile duct enters the duodenum. At the same time, the gallbladder contracts and pushes the accumulated bile into the common bile duct and further into the duodenum. The pancreas closely cooperates with this system, which secretes its own pancreatic juice – one and a half to two liters per day. This juice is rich in powerful digestive enzymes and plays a leading role in the digestion of food. The juice enters the duodenum through the pancreatic duct, which connects to the common bile duct at the duodenum itself. Thus, the sphincter of Oddi regulates the flow of both bile and pancreatic juice into the duodenum. The general regulation of the coordinated work of these organs is carried out by the nervous and endocrine systems of the body.

It must be understood that this model is simplified and devoid of details. For each individual, it has its own characteristics – its size of the liver and gallbladder, various shapes, length, width of the cystic and other ducts. The gallbladder and bile ducts are combined into the biliary system.

Nuance

Western clinics recommend cholecystectomy – removal of the gallbladder – as the most acceptable method of treatment for patients with hypomotor dysfunction of the gallbladder. In Russia, this method is perceived with caution, and drug correction of these disorders is widely used. In the treatment of hypermotor dysfunction, antispasmodics, anticholinergics, and sedatives are used. In order to correct hypokinetic dysfunction, choleretic drugs, enzymes containing bile acids are prescribed.

***

Cholecystitis is divided into two large groups: calculous (lat. Calculus – stone) and non-calculous (non-calculous). Gastroenterologist Elena Grishchenko, Professor of the Department of Therapy of the PhUV of the Krasnoyarsk Medical University, talks about the manifestations and treatment of non-calculous cholecystitis.

The disease begins gradually, often in adolescence. Complaints arise under the influence of a violation of the diet, psycho-emotional overstrain. The manifestations of chronic cholecystitis are diverse and do not have specific features. The “symptom of the right hypochondrium” is considered classic: dull, aching pain in the right hypochondrium of a permanent nature or occurring one to three hours after taking a rich and especially fatty and fried food. The pain radiates upward, to the region of the right shoulder and neck, the right shoulder blade. Periodically, there may be a sharp pain, resembling biliary colic.

With a long course of the disease, the solar plexus is involved in the inflammatory process, and then there is a burning pain in the navel, radiating to the back.

Dyspeptic phenomena are not uncommon: a feeling of bitterness and a metallic taste in the mouth, belching with air, nausea, flatulence, impaired defecation: often alternating constipation and diarrhea. Irritability, insomnia often occurs due to itching. It appears when bile pigments accumulated in the blood begin to irritate skin receptors. And if a person suffers from allergies, an allergic reaction may develop, up to Quincke’s edema. Pain attacks may be accompanied by weakness, sweating, palpitations, headache, chills, fever.

The course of cholecystitis in most cases is long, with alternating periods of remission and exacerbations; the latter often occur as a result of malnutrition, the intake of alcoholic beverages, hard physical work, the addition of acute intestinal infections, and hypothermia.

To confirm the diagnosis of exacerbation of chronic non-calculous cholecystitis, the gastroenterologist will prescribe laboratory and instrumental studies.

1. Complete blood count – detects inflammation.

2. Biochemical blood test – quantitative changes in bilirubin, alkaline phosphatase and other indicators will indicate violations of the functioning of the biliary system.

3. The main diagnostic criterion for chronic cholecystitis is an ultrasound of the gallbladder. First of all, the presence of stones in the gallbladder and in the ducts is excluded. The thickness and density of the gallbladder wall testifies to the severity of the inflammatory process. As well as the so-called “sludge” – stagnation and thickening of bile and deformation of the gallbladder.

4. In some cases, ultrasound is performed with a choleretic breakfast – an opportunity to determine how the gallbladder functions in dynamics. Egg yolks, fat sour cream or cream are used as breakfast.

5. Duodenal sounding – performed only in the absence of stones in the gallbladder. Bile sampling through an umbrella inserted into the duodenum is carried out every ten minutes. This allows you to determine the type of bladder motility (hyper- or hypo-), the tone of the sphincter of Oddi. In the study of bile, inflammatory elements are detected – mucus, leukocytes, as well as the presence of bacterial flora, for example, eggs of the Siberian fluke.

6. Drug tests with choleretic drugs.

7. ECG – to exclude diseases of the cardiovascular system.

8. Computed tomography and nuclear magnetic resonance – studies are carried out in cases that are difficult to diagnose.

Dysfunctions of the biliary tract often appear under the mask of cholecystitis. Therefore, a careful comparison and rigorous analysis of all studies is required to make a diagnosis of chronic cholecystitis. This will be done by a gastroenterologist. If necessary, he will consult the patient with other specialists – a surgeon, a cardiologist, a gynecologist, a psychotherapist.

When exacerbation of chronic non-calculous cholecystitis is confirmed by laboratory tests, antibiotic treatment is prescribed. The choice of antibiotics is carried out by the doctor, taking into account the ability of this drug to concentrate in bile.

To normalize the function of the biliary tract and eliminate pain, myospasmolytics, anticholinergics, analgesics are prescribed.

In the phase of fading exacerbation and in the phase of remission, with identified hypomotility of the gallbladder, choleretic drugs are prescribed – choleretics. They, increasing the secretion of bile, increase its flow through the bile ducts, which reduces the intensity of the inflammatory process and prevents the spread of ascending infection. Choleretics can not be used in the midst of inflammation and with concomitant pathology of the liver, pancreas; after removal of the gallbladder.

To correct intestinal disorders, choleretic preparations are used together with enzymes.

Mineral water is used as a choleretic agent during remission. It stimulates the contraction of the gallbladder. Has anti-inflammatory action. What kind of mineral water to drink, warm or hot, before meals or after, the doctor selects individually for each patient.

Physiotherapy and spa treatment is an important component of the complex rehabilitation of patients. Courses of physiotherapy are selected by a physiotherapist individually for each patient. Sanatorium treatment is indicated no earlier than two to four months after an exacerbation of cholecystitis. Patients are sent to balneo-mud resorts: Essentuki, Zheleznovodsk, Truskavets, Morshyn.

Adequate therapy of chronic cholecystitis and correction of motor-evacuation disorders of the gallbladder give good results and prevent the development of cholelithiasis.

Nutrition

In the period of exacerbation, in the first two days, only warm liquids are prescribed: weak sweet tea, juices from fruits and vegetables diluted with water, mineral water without gas in small portions up to 1.5 liters per day and several crackers. As the pain subsides and the general condition improves, the dietary table expands. Recommended:

– pureed soups from vegetables and cereals,

– cereals: oatmeal, rice, semolina, buckwheat,

– kissels, mousses, jelly, low-fat cottage cheese,

– low-fat boiled fish,

– pureed and boiled meat, steam cutlets: veal, chicken, turkey, rabbit,

– white crackers.

After relief of exacerbation of cholecystitis, patients are recommended the following diet:

— milk, fruit, vegetable broth soups with cereals, noodles;

– boiled meat, steam cutlets, meatballs: beef, rabbit, chicken, turkey;

– low-fat varieties of sea or river fish, boiled or baked, without rind;

– eggs, up to one or two per day – soft-boiled, in the form of steam omelettes;

– dairy products: low-fat milk, cottage cheese, kefir, yogurt, curdled milk;

– boiled, baked vegetables, partially raw.

– fruits and berries;

– porridge – buckwheat, oatmeal, rice, semolina, with the addition of milk, if tolerated;

– sweet dishes – marshmallow, marmalade, m d, jams, preserves, jelly;

– flour products – wheat and rye bread, yesterday’s bread, white bread crackers, dry non-bread cookies.

Eat small meals, slowly, five to six times a day. Long breaks between meals, fasting are not recommended. Breakfast is required, dinner two to three hours before bedtime, not plentiful.

Foods not recommended:

– high in animal fats: fried foods, fatty fish, pork, lamb, duck, sausages, smoked meats, mayonnaise, creams, cakes, pastries;

– raw onion, garlic, radish, sorrel, spinach, mushrooms, peas, beans;

– cold and carbonated drinks, concentrated juices, coffee, cocoa, alcoholic drinks.

Topic

If not treated, the disease progresses, complications begin.

1. Pericholecystitis occurs when all the walls of the gallbladder and the serous membrane (peritoneum) are involved in the pathological process. In this condition, the pain syndrome is constant and intense, spreads to the right side, increases when turning and tilting the torso.

2. Cholangitis is an inflammatory process in the bile ducts. The main symptom is an increase in temperature up to 40 degrees with tremendous repeated chills, nausea, vomiting, cramping pains in the right hypochondrium.

3. When other organs of the digestive system are involved in the pathological process, along with pain in the right hypochondrium, pain sensations of a “girdle” character appear, loosening of the stool – it is possible to involve the pancreas in the pathological process. If the pain spreads to the entire area of ​​the liver and is accompanied by its increase – the attachment of reactive hepatitis. The occurrence of late, hungry pains in the upper abdomen indicates the presence of duodenitis inflammation of the duodenum.

Complications not only cause disability, but also pose a threat to the patient’s life, so when the first symptoms of the disease appear, you should immediately consult a general practitioner or gastroenterologist.

Cholelithiasis (GSD) – Department of Surgery – Clinical Departments – Departments and Specialists – Central Clinical Hospital “RZD-Medicine”

Gallstone disease is a common disease that develops in people over the age of 40. Especially often this disease is observed among the urban population of industrialized countries. According to most researchers, about 10% of men and up to 25% of women in Europe suffer from gallstone disease.

With cholelithiasis, calculi (stones) are formed in the gallbladder and bile ducts. These stones are composed of the usual components of bile – bilirubin, cholesterol, calcium salts. Most often there are mixed stones containing a greater or lesser proportion of these components. If the calculus is 90% cholesterol, then such a stone is called “cholesterol”, if from bilirubin – “pigment”, and if from calcium salts – “calcareous”. The size and shape of stones in cholelithiasis can be different. The sizes generally vary from 1–2 mm to 3–5 cm; the shape can be round, oval, in the form of a polyhedron, etc.

Causes of gallstone disease

The main site for the formation of gallstones is the gallbladder, in very rare cases – the biliary tract. Currently, in clinical medicine, there are three main causes of their formation: stagnation of bile in the bladder, metabolic disorders, inflammatory changes in the wall of the gallbladder . In case of metabolic disorders, there is a change in the ratio of concentrations of cholesterol, phospholipids (lecithin) and bile acids in bile. The concentration of cholesterol increases, and phospholipids decreases. Such bile is considered to be lithogenic. Under such conditions, bile cholesterol easily precipitates in the form of crystals, these crystals are grouped together, combined with each other, which leads to the formation of stones. It is known that cholelithiasis often develops in patients with metabolic diseases such as diabetes, obesity, hemolytic anemia. With prolonged stagnation of bile in the bladder, it becomes infected. The infection leads to damage to the wall of the gallbladder, desquamation of its epithelium. All this contributes to a more rapid deposition of cholesterol crystals and the formation of gallstones. In the damaged wall of the gallbladder, the process of absorption of some components of bile is disrupted, their physicochemical ratio changes, which also contributes to stone formation. In addition, with cholestasis in the bile in the gallbladder, the concentration of cholesterol, bilirubin, and calcium may increase, which increases the lithogenicity of bile. This is facilitated by the intake of food rich in cholesterol, obesity, oral contraceptives.

Clinical manifestations of gallstone disease

Gallstone disease can be asymptomatic (the so-called latent form of cholelithiasis). At the same time, gallstones are found as an accidental finding when examining patients for another disease.

Patients with gallstones may experience dyspeptic disorders : unpleasant metallic taste, bitterness in the mouth, nausea, bloating, feeling of heaviness in the right hypochondrium, especially after eating fatty foods. Such phenomena are caused by a violation of the motility of the biliary tract and the gastrointestinal tract with the reflux of bile into the stomach and esophagus. This form of cholelithiasis is called dyspeptic.

The classic clinical manifestation of cholelithiasis is hepatic (biliary) colic, which is characterized by intense cutting, stabbing, tearing, less often paroxysmal pain in the right hypochondrium and epigastric region. These pains often radiate to the lumbar region, right shoulder blade, right forearm. Also, pain can spread to the region of the heart and be mistakenly perceived as an angina attack. Pain occurs most often after an error in the diet (eating fatty, spicy foods), during physical exertion, psycho-emotional overstrain, shaky driving. The occurrence of pain is associated with the movement of stones in the biliary tract and their infringement in the neck of the gallbladder or cystic duct, increased pressure in the gallbladder or ducts due to a violation of the outflow of bile. Often an attack of hepatic colic is accompanied by nausea and repeated vomiting with an admixture of bile, which does not bring relief to the patient. Colic can last from a few minutes to several hours. At the same time, patients are restless, often change their position, trying to find a comfortable position in which the intensity of pain decreases. This form of gallstone disease is called pain paroxysmal.

Diagnosis of cholelithiasis

The diagnosis of cholelithiasis is made on the basis of: patient complaints, anamnesis of the disease, physical examination by a doctor and mainly according to instrumental examination. At the same time, to make a diagnosis, very often it is enough to conduct only one ultrasound examination (ultrasound) of the abdominal organs, in which calculi are found in the lumen of the gallbladder or in the ducts. Examination of the patient can also be supplemented by X-ray examination. In this case, radiopaque techniques are used, such as oral cholecystography or intravenous cholecystocholangiography. In the first method, a few hours before the x-ray, the patient takes a special radiopaque drug inside, which is captured by the liver cells and excreted into the bile. With cholecystocholangiography, a radiopaque drug is injected intravenously, it is also captured by the liver cells and excreted into the bile. After contrasting, an x-ray is taken and if a defect in the filling of the lumen of the gallbladder or ducts is detected, then this may indirectly indicate the presence of calculi (stones) in them, although both polyps and a cancerous tumor of the gallbladder can give the same x-ray picture. Currently, the X-ray method for diagnosing cholelithiasis is practically not used due to its low information content, low efficiency, and lack of ease of use.

Treatment of gallstone disease

Currently, surgical treatment is the only possible way to radically get rid of gallstone disease.

Until now, there are no effective drugs that can cause the dissolution of stones in the gallbladder and bile ducts. Some drugs can dissolve only certain types of stones, but with prolonged use they cause serious side effects and complications.

There is an alternative less traumatic surgical method for the treatment of gallstone disease, such as extracorporeal shock wave lithotripsy. The essence of the method lies in the destruction of gallstones by a shock wave reproduced by a special device. The shock wave is strictly focused on the gallbladder, under its influence, stones are crushed into small fragments and sand, which in some cases, together with bile, go into the duodenum. Despite the simplicity of this method of treatment and its low trauma, the effectiveness of treatment remains very low even today. This is due to the fact that not all stones can be crushed. In 10–30% of cases, fragments of destroyed stones are large and cannot exit through the natural opening of the common bile duct. In this case, they can be pinched in the neck of the gallbladder and lead to a severe attack of hepatic colic, or get stuck in the common bile duct and disrupt the outflow of bile into the duodenum, which will lead to the development of obstructive jaundice. Both of these conditions require immediate hospitalization in a surgical hospital! The shock wave destroys not only stones, but in some cases causes serious damage to the liver and gallbladder walls. The use of extracorporeal lithotripsy in patients with cholelithiasis should be carried out according to certain indications: single cholesterol (X-ray negative) stones with a diameter of no more than 3 cm, occupying no more than half of a well-functioning gallbladder. This bloodless method is especially indicated in the treatment of elderly and senile patients. Contraindications for lithotripsy are: x-ray positive stones (with the inclusion of calcium salts), stone diameter more than 3 cm, multiple stones occupying more than half of the gallbladder, disabled gallbladder, frequent renal colic in history, inflammatory diseases of the hepatoduodenal zone.

To date, many methods have been developed for the surgical treatment of gallstone disease. With any type of surgical treatment, complete removal of stones is performed along with the gallbladder – the main pathogenetic substrate of the disease! This completely eliminates the return of the disease.

Absolute indications for surgical treatment of gallstone disease are:

• severe attacks of hepatic colic in history;
• the presence of large stones that can cause a decubitus of the bladder wall;
• the risk of developing gallbladder cancer, which occurs in 5% of patients with long-term gallstone disease;
• small bladder stones that can block the cystic duct, penetrate the common bile duct and cause obstructive jaundice, cholangitis, biliary acute or chronic pancreatitis.

A relative indication for surgical treatment is the presence of latent and dyspeptic forms of cholelithiasis.

The main type of surgery for cholelithiasis is the traditional (open) cholecystectomy (removal of the gallbladder). At the same time, various types of accesses (cuts) are performed through the anterior abdominal wall, penetrate into the abdominal cavity. After intraoperative revision of the gallbladder, extrahepatic bile ducts, duodenum and pancreas, assessment of the nature of pathological changes, its complete removal is performed. The classical approach provides wide access to the hepatobiliary zone and a good overview of all interested organs, however, it is associated with significant tissue trauma (especially the anterior abdominal wall), which leads to a rather long period of postoperative rehabilitation and a higher risk of complications from the operating room compared to minimally invasive techniques. wounds.

Currently, the most popular are minimally invasive surgical interventions in the treatment of gallstone disease, such as cholecystectomy from a mini-access and laparoscopic cholecystectomy.

Benefits of laparoscopic surgery

Pain in the postoperative period is insignificant, and, as a rule, is noted only on the first day.

The patient immediately after coming out of anesthesia (a few hours after the operation) can walk and take care of himself.

The length of stay in the hospital is much reduced (up to 1-4 days), as well as the recovery time.

The number of postoperative hernias is reduced several times.

Laparoscopic surgery is a cosmetic operation, after a few months, scars after punctures in most patients become almost invisible.

Cholecystitis – inflammation of the gallbladder

Often develops with cholelithiasis (the so-called stone cholecystitis, up to 80–90% of the total number of diseases [1]), after viral hepatitis and other infectious diseases, in the presence of chronic focal infection (for example, tonsillitis) or parasitic diseases (for example, opisthorchiasis). The development of cholecystitis is facilitated by stagnation and changes in the composition of bile, which may be associated with nutritional characteristics. Often cholecystitis is combined with cholangitis.

There are calculous (presence of gallstones in the bladder) and acalculous, acute and chronic cholecystitis.

Diagnosis of cholecystitis

• Ultrasound of the abdominal organs with examination of the gallbladder, bile ducts, pancreas.
• General and biochemical analysis of blood.
• X-ray examination (with the development of obstructive jaundice and suspicion of the presence of stones in the bile ducts).

Acute cholecystitis

The main signs of acute cholecystitis: paroxysmal pain in the right side of the abdomen, radiating to the right shoulder, shoulder blade; nausea and vomiting; chills and fever; possible jaundice and itching of the skin. A dangerous complication of acute cholecystitis is peritonitis. Shown cholecystostomy (Greek chole bile + kystis bladder + stoma opening, passage) – external drainage of the gallbladder when other interventions are impossible.

The presence of gallstones is an indication for surgery.

This is due to the fact that the presence of stones in the gallbladder can at any time lead to acute cholecystitis, its necrosis with the development of complications:

• empyema of the gallbladder – infection of the contents of the gallbladder;
• dropsy of the gallbladder – a violation of the outflow of bile, but without infection, while the absorption of bile elements occurs, and the bladder remains filled with transparent contents;
• phlegmon of the gallbladder – purulent inflammation of the wall of the gallbladder;
• subhepatic abscess;
• bilious fistulas;
• peritonitis, sepsis are deadly complications that can develop with the progression of the above complications.

With the development of complications, the operation is performed on an emergency basis and is associated with a high risk of complications, and the rehabilitation period ranges from several weeks to several months!!!

Chronic cholecystitis

Chronic cholecystitis can be acalculous or calculous, from the Latin word calculus, which means stone. Calculous cholecystitis is one of the results of gallstone disease. Chronic cholecystitis is manifested by nausea, dull pain in the right hypochondrium, and other unpleasant sensations that occur after eating. In the recognition of cholecystitis, laboratory data and cholecystocholangiography play an important role.

The most formidable complication of calculous cholecystitis is hepatic colic. If a small (less than 1 cm) stone does not pass in the biliary tract, plugging the flow of bile, then bile pigments enter the bloodstream and subhepatic jaundice develops.

The symptoms of colic are very similar to the onset of acute cholecystitis.