What are gallstones and how do they form. How can you recognize the symptoms of gallstones. What treatments are available for gallstones. Who is at risk of developing gallstones. How are gallstones diagnosed and prevented.

Understanding Gallstones: Formation and Composition

Gallstones are hard deposits that form within the gallbladder, a small organ located beneath the liver. These stones develop when there’s an imbalance in the substances that make up bile, a digestive fluid produced by the liver and stored in the gallbladder. The majority of gallstones (about 80%) are composed of cholesterol, while others are made of bilirubin, a yellowish pigment produced when red blood cells break down.

How do gallstones form? Typically, bile acids break down cholesterol. However, when the liver produces excess cholesterol that these acids can’t process, the surplus solidifies into stones. Similarly, an overabundance of bilirubin in the bile can lead to stone formation. Incomplete emptying of the gallbladder may also contribute to gallstone development.

Types of Gallstones

• Cholesterol stones: The most common type, formed when excess cholesterol in bile crystallizes
• Pigment stones: Composed primarily of bilirubin, these are less common and often associated with certain medical conditions
• Mixed stones: Containing both cholesterol and pigment components

Do gallstones vary in size? Indeed, they can range from tiny granules as small as a grain of sand to larger formations comparable to a golf ball. The size and number of gallstones can influence the severity of symptoms and treatment options.

Recognizing the Symptoms of Gallstones

Many individuals with gallstones remain asymptomatic, a condition referred to as “silent gallstones.” However, when symptoms do occur, they can be quite distressing. A gallbladder attack, characterized by intense pain, typically happens when a gallstone obstructs a bile duct.

Common Symptoms of Gallstones

• Severe pain in the upper right abdomen
• Pain radiating to the upper back
• Sudden onset of pain, often lasting several hours
• Nausea and vomiting
• Fever (in cases of gallbladder inflammation)
• Jaundice (yellowing of the skin and eyes)

When do gallbladder attacks typically occur? These episodes often follow heavy meals and are more likely to happen in the evening or during the night. The pain subsides once the gallstone dislodges and no longer blocks the duct. However, prolonged blockage can lead to complications, necessitating immediate medical attention.

Risk Factors for Gallstone Formation

While gallstones can affect anyone, certain factors increase the likelihood of their development. Understanding these risk factors can help individuals take preventive measures and seek timely medical advice.

Who is More Prone to Gallstones?

1. Women: Estrogen increases cholesterol in bile, making females more susceptible
2. Older adults: The risk increases with age, especially after 60
3. Individuals with diabetes
4. Those with a family history of gallstones
5. Pregnant women
6. People using hormonal birth control
7. Individuals consuming high-fat diets
8. Overweight or obese individuals
9. Those experiencing rapid weight loss

How does weight affect gallstone formation? Obesity increases cholesterol in bile, while rapid weight loss can cause the liver to secrete extra cholesterol into bile, both of which can lead to gallstone formation.

Diagnostic Approaches for Gallstones

Diagnosing gallstones can be challenging due to the similarity of symptoms with other conditions. Healthcare providers employ a combination of physical examination, laboratory tests, and imaging studies to confirm the presence of gallstones.

Common Diagnostic Methods

• Physical examination: Checking for abdominal tenderness and jaundice
• Blood tests: To assess liver function and detect inflammation
• Ultrasound: The primary imaging technique for visualizing gallstones
• CT scan: Provides detailed images of the gallbladder and surrounding structures
• HIDA scan: Evaluates gallbladder function and detects blockages
• ERCP: Used to diagnose and potentially treat gallstones in the bile duct

Why is ultrasound the preferred initial imaging test? Ultrasound is non-invasive, doesn’t use radiation, and can effectively detect gallstones with high accuracy. It’s also relatively inexpensive compared to other imaging modalities.

Treatment Options for Gallstones

The treatment approach for gallstones depends on the severity of symptoms, the size and location of the stones, and the overall health of the patient. While some cases may not require immediate intervention, others may necessitate surgical removal of the gallbladder.

Non-Surgical Treatments

• Watchful waiting: For asymptomatic gallstones
• Ursodeoxycholic acid: Oral medication to dissolve small cholesterol stones
• Lithotripsy: Sound waves to break up stones (limited applicability)

Surgical Interventions

• Laparoscopic cholecystectomy: Minimally invasive removal of the gallbladder
• Open cholecystectomy: Traditional surgery for complex cases

Why is cholecystectomy often recommended? Once a patient experiences a gallbladder attack, the likelihood of recurrence is high (up to 70%). Removing the gallbladder eliminates the risk of future attacks and potential complications like infection or gallbladder rupture.

Preventing Gallstone Formation

While not all gallstones can be prevented, adopting certain lifestyle modifications can reduce the risk of their formation. These preventive measures focus on maintaining a healthy weight, balanced diet, and regular physical activity.

Lifestyle Changes to Reduce Gallstone Risk

1. Maintain a healthy weight through balanced diet and exercise
2. Avoid rapid weight loss or extreme dieting
3. Consume a diet low in saturated fats and high in fiber
4. Stay hydrated by drinking plenty of water
5. Exercise regularly to help maintain a healthy weight
6. Limit alcohol consumption
7. Avoid skipping meals, as this can increase bile concentration

How does diet influence gallstone formation? A diet high in saturated fats can increase cholesterol levels in bile, promoting stone formation. Conversely, a diet rich in fiber may help prevent gallstones by reducing bile cholesterol.

Complications Associated with Gallstones

While many gallstones remain asymptomatic, untreated symptomatic gallstones can lead to serious complications. Understanding these potential issues underscores the importance of timely medical intervention when symptoms arise.

Potential Complications of Gallstones

• Cholecystitis: Inflammation of the gallbladder
• Choledocholithiasis: Blockage of the common bile duct
• Cholangitis: Infection of the bile ducts
• Pancreatitis: Inflammation of the pancreas due to gallstone blockage
• Gallbladder cancer: Rare but serious long-term complication

Can gallstones lead to liver problems? While gallstones primarily affect the gallbladder, they can indirectly impact liver function if they obstruct bile flow, potentially leading to jaundice or liver inflammation.

Living Without a Gallbladder: Post-Cholecystectomy Considerations

For many patients, surgical removal of the gallbladder (cholecystectomy) is the definitive treatment for gallstones. While the gallbladder serves a purpose in storing and concentrating bile, its removal doesn’t typically cause significant long-term issues for most individuals.

Adapting to Life After Gallbladder Removal

1. Dietary adjustments: Gradually reintroducing fats to the diet
2. Potential digestive changes: Some may experience looser stools initially
3. Bile flow adaptation: The body adjusts to continuous bile flow into the intestines
4. Nutritional considerations: Ensuring adequate fat-soluble vitamin absorption

How does the body compensate for the absence of a gallbladder? After cholecystectomy, the liver continues to produce bile, which flows directly into the small intestine. The body adapts to this continuous flow, and most people can resume a normal diet and lifestyle after recovery.

Gallstones, while common, can range from asymptomatic to severely painful conditions requiring medical intervention. Understanding the risk factors, recognizing symptoms, and knowing when to seek medical attention are crucial for managing this condition effectively. While prevention isn’t always possible, maintaining a healthy lifestyle can significantly reduce the risk of gallstone formation. For those requiring treatment, modern medical approaches offer various options, from non-invasive techniques to minimally invasive surgery, ensuring better outcomes and quicker recovery times for patients dealing with gallstones.

Gallstones – familydoctor.org

What are gallstones?

Gallstones are hard deposits that can form inside the gallbladder. The gallbladder is a small, pear-shaped organ just under your liver. It stores bile, the digestive fluid that is made by the liver. Sometimes the bile becomes solid and forms stones. Some are as small as a grain of sand. Others can be the size of a golf ball.

Symptoms of gallstones

Most people who have gallstones never experience symptoms. These are called silent gallstones. Sometimes, a gallstone can leave your gallbladder and go into a bile duct. If a gallstone gets stuck in that passageway and blocks it completely, you may experience:

• Severe pain in the right upper part of your belly.
• Pain in your upper back.

This is known as a gallbladder attack. The pain usually starts suddenly and lasts for several hours. Complete or partial blockage can also cause your gallbladder to get irritated and inflamed. If this happens, you may:

• Have pain that lasts several hours.
• Develop a fever.
• Vomit or feel nauseated.

In addition, your skin may turn a yellowish color, known as jaundice.

Gallbladder attacks tend to happen after heavy meals. They’re more likely to happen in the evening or during the night. They stop when the gallstones move and are no longer lodged in the duct. If the duct remains blocked for more than a few hours, complications can occur. Call your doctor right away if you’re experiencing a gall bladder attack that lasts more than several hours.

What causes gallstones?

Gallstones are causes by imbalances in the substances that make up bile.

Most gallstones (80%) are made of cholesterol. Normally, acids in the bile break down cholesterol. But a high-fat diet can lead the liver to produce extra cholesterol that the acids can’t break down. This leads the excess cholesterol to solidify. Other gallstones are made of bilirubin. Bilirubin is a yellowish pigment in bile that is produced when red blood cells break down. These stones are formed when there is too much bilirubin in the bile.

Gallstones may also form if the gallbladder doesn’t empty itself completely.

You’re more likely to get gallstones if you:

• Are a woman.
• Are more than 60 years of age.
• Have diabetes.
• Have a family history of gallstones.
• Are pregnant.
• Take birth control pills.
• Eat a diet high in fat.
• Are overweight or obese.
• Are on a low-calorie diet and have recently lost weight very quickly.

How are gallstones diagnosed?

Gallstones can be hard to diagnose because they share symptoms with other conditions. Your doctor will do a physical exam to look for signs of gallstones. This will include looking for yellowing of the skin and tenderness in the abdomen. He or she may order blood tests. They may also order imaging tests. These could include an ultrasound or CT scan, which will make pictures of your gallbladder and bile ducts. If your doctor thinks you have a gallstone stuck in a bile duct, they could try to remove the stone.

Can gallstones be prevented or avoided?

In most cases, gallstones can’t be prevented or avoided. Eating a healthy diet, maintaining a healthy weight, and avoiding rapid weight loss could reduce your risk.

Gallstones treatment

Your treatment depends on the severity of your symptoms and what the doctor finds from the tests.

• No treatment.If the gallstones are floating free and you have no pain, you won’t need treatment.
• Wait and see.If you have one gallbladder attack, your doctor may want to take a wait-and-see approach. The problem may solve itself. Then if you have more attacks, your doctor may recommend surgery.
• Surgery. Once you have one gallbladder attack, the chance of having another one is high (up to 70%). Many doctors will suggest surgery to remove your gallbladder to prevent a future attack. If your gallbladder is irritated or inflamed, most doctors will want to take it out right away. The surgery is most often done with laparoscopic surgery. This means that small tools are inserted into small incisions in your abdomen to remove your gallbladder. The surgery is safe and effective. It limits your hospital stay to about 1 day. Without surgery, the gallbladder can get infected. It might even burst, causing further problems.

Are there other treatments?

Other treatments are available for people who would have a high risk in surgery. This could be because they are elderly, or have heart problems or lung disease. However, gallstones usually return when they aren’t treated with surgery. Other options include:

• Sound wave therapy.This can break up the stones so they can move into the intestine without problem. But not everyone can receive this treatment. If you have more than 1 gallstone, if your gallstone is large, or if you have other medical conditions, you may not be able to receive sound wave therapy.
• Medicine. You might be able to take a pill to dissolve the stones. This pill doesn’t work for everyone and can be expensive. It can take 2 years or longer to work, and gallstones could return after you finish treatment.

Surgery is the best way to cure symptomatic gallstones. Talk with your doctor about what is right for you.

Living with gallstones

If your gallstones aren’t causing symptoms, you may live the rest of your life without any problems. If you do experience symptoms, your doctor may want to remove your gallbladder. You don’t need your gallbladder to live. So when it’s removed, you won’t notice much difference. You may have diarrhea at first. If you have diarrhea that lasts more than 3 months after surgery, talk to your doctor. Some people may find they need to eat a lower-fat diet.

Questions to ask your doctor

• Are there lifestyle changes I can make to prevent gallstones?
• Am I at risk of having another gallstone?
• What should I do if I have a gallbladder attack?
• Is there any kind of medicine that will make a gallbladder attack less painful?
• Will I need surgery to remove my gallbladder? Are there other options?
• Is having a gallstone a sign of another condition?

Resources

National Institutes of Health, MedlinePlus: Gallstones

National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases: Gallstones

4 Things You Should Know About Gallstones

Do you have severe abdominal pain? You could have gallstones.

Learn more about the signs and symptoms.

Tucked beneath your liver, the gallbladder is a seemingly inconsequential organ that stores bile from your liver. When this bile passes to your small intestine, it helps digest fatty foods. However, when gallstones occur, the pain can be debilitating.

1. What are gallstones and their symptoms?

Gallstones form when small bits of crystalized bile clump together. These stones can be as small as a grain of salt or as large as an egg. When they stay put in the gallbladder, these “silent” gallstones go unnoticed and do not require treatment. When they try to pass through the tiny bile duct to the small intestine, inflammation and severe pain set in. Lasting from a few minutes to a few hours, the pain can feel like indigestion or similar to a feeling of fullness.

Additional symptoms include:

• Severe abdominal pain, with no relief from pain relievers
• Pain that worsens after eating a meal, particularly foods high in fat
• Chest pain
• Excessive gas and heartburn
• Tenderness in the abdomen, especially on the upper right side
• Jaundice
• Nausea
• Pancreatitis

 “While pain can be a symptom of gallstones, it’s important to know that they often manifest as more of a vague discomfort rather than pain,” says Hector C. Ramos, MD, a hepatobiliary and pancreatic surgeon at Keck Medicine of USC. “They’re most often found when a primary care doctor does an ultrasound, because a patient comes in with what they believe to be indigestion or abdominal distress.”

2. Who is at risk for gallstones?

Gallstones have become increasingly common, and all age groups can be affected.

Factors that contribute to gallstones include:

• Obesity
• An increase in estrogen, from pregnancy or hormone therapy
• A diet high in fat and refined carbohydrates, and a decrease in fiber

A family history of gallstones, as well as multiple pregnancies, can increase risk. Likewise, there is a higher percentage in older people; about 25% of women age 60 or older will develop them.

3. How are gallstones treated?

An X-ray, CT scan or ultrasound will confirm whether you have gallstones. If you don’t have any symptoms, most likely you’ll simply live with them, until you do. After treating your gallstones, changing to a vegetarian diet or one that includes preventive factors, like polyunsaturated fat, monounsaturated fat, fiber and caffeine, is suggested.

“A vegetarian diet will prevent gallstones,” says Ramos. “However, if you have already been diagnosed with gallstones, it’s best not to change suddenly to a strict vegetarian diet. The rapid shift from the gallbladder being very active and frequently digesting fats to not being used at all can aggravate your condition and produce more gallstones. Crash-diet plans that cause a rapid loss of a great deal of weight can also produce or aggravate gallstones. If you’re considering weight management surgery, talk to your surgeon about the potential for gallstones.”

If your doctor decides to remove your gallbladder, a cholecystectomy might be suggested. For this procedure, a surgical incision is made, and then the gallbladder is removed by laparoscopic surgery. Most patients experience a quick recovery with little pain and discomfort.

“Not all gallstones need to be surgically removed,” Ramos says. “Sometimes, a physician will find gallstones, when doing a procedure for kidney stones, for example. If they aren’t causing you symptoms, the gallbladder may not need to be removed. But if you have persistent pain, surgery is the best option. Patients who are immunosuppressed are also advised to get surgery, as gallstones can lead to a potentially fatal infection.”

4. Are there complications with gallstones?

Even if you aren’t in pain from your gallstones, they may still present a health risk. Jaundice, where your skin itches and appears yellow, is one side effect. Another is acute cholecystitis, where the stone blocks the cystic duct, preventing the gallbladder from emptying bile into the bile duct. Nausea, vomiting and severe pain are usually present. In the most serious cases, patients may develop acute pancreatitis, also treated with surgery. Usually, patients return to normal lives, after having their gallbladder removed.

“The best way to prevent gallstones is to eat a moderate diet that is low in fat and simple carbohydrates, such as sugar and refined flour,” says Ramos. “Obesity is associated with gallstones, so do your best to keep your weight in a healthy range. The best prevention is a moderate, balanced diet that is low in fat. Get your carbohydrates from fresh, whole fruits and vegetables. You should also drink lots of water to keep your bile fluid.”

Topics

abdominal pain

Dr. Hector C. Ramos

gallbladder surgery

gallstones

Anne Fritz

Anne Fritz is a freelance health and lifestyle writer.

90,000 symptoms, treatment. What causes stones in the gallbladder?

The disease ranks third in prevalence after cardiovascular and endocrine pathologies. The disease is more often diagnosed in women.

Gallbladder stones: causes and mechanism of disease development

Stones in the gallbladder and bile ducts are formed due to a violation of the process of metabolism of bile components. Pathology develops with the simultaneous presence of the following factors: the production of lithogenic bile (oversaturated with cholesterol), an imbalance between the activity of pronucleating and antinucleating components, and a decrease in the contractile function of the gallbladder.

Among the main causes of gallstone disease are:

• hereditary factor;
• overweight;
• dramatic weight loss;
• eating foods high in cholesterol and low in fiber;
• inflammatory processes and biliary dyskinesia;
• taking oral contraceptives;
• malabsorption syndrome;
• disorders in the work of the endocrine system;
• Crohn’s disease;
• liver disease.

Also, the disease can develop during pregnancy.

There are 2 main mechanisms for the development of the process of formation of stones in the gallbladder: vesicoinflammatory and hepatometabolic. The first variant develops against the background of an inflammatory process, leading to a violation of the acid-base balance of bile and a decrease in the protection of protein fractions, which causes crystallization of bilirubin. Further, the epithelium and mucus join it, which causes the formation of a calculus. In the second case, the disease develops against the background of a violation of the metabolic processes of the liver, which is often the result of existing liver diseases, unbalanced nutrition, endocrine disorders, hypothyroidism.

Symptoms of cholelithiasis

The disease develops gradually and may not manifest itself in the early stages. The average growth rate of stones is 3-5 mm per year, so the first symptoms often appear only after a few years.

Symptoms of gallstone disease are varied and depend on the location of the stones, their size, etc. You can suspect stones in the gallbladder by the following signs:

• pain and heaviness in the right hypochondrium;
• taste of bitterness in the mouth;
• nausea;
• flatulence and other bowel disorders;
• belching of air;
• yellowing of the skin and mucous membranes.

Many of these symptoms may indicate other diseases, so for an accurate diagnosis, you need to see a doctor. You can contact a general practitioner or go directly to a gastroenterologist. The main method for diagnosing cholelithiasis is ultrasound, it allows not only to confirm the diagnosis, but also to determine the exact localization of stones and their size.

Treatment of cholelithiasis

If stones are found in the gallbladder, treatment should be started immediately. Otherwise, the disease will progress and lead to complications, including: acute cholecystitis, pancreatitis, perforation of the gallbladder, stones in the intestines and the formation of intestinal obstruction. Also, over time, the disease can provoke the development of an oncological process in the gallbladder.

The possibilities of modern medicine make it possible to successfully treat gallstone disease. The main thing is to choose the right tactics. There are 2 main options here:

• conservative treatment;
• surgery.

Conservative treatment is aimed at dissolving stones with the help of special preparations and crushing them with the help of a laser or ultrasound. There are a number of contraindications to these methods of treatment, besides, it does not always completely solve the problem, therefore, an operation is often prescribed for stones in the gallbladder – cholecystectomy, which involves the removal of the gallbladder.

To date, most often the removal of the gallbladder is carried out by the modern laparoscopic method, since the strip operation requires a longer rehabilitation. Laparoscopy is performed under general anesthesia: the surgeon makes 2-4 punctures of the abdominal wall. A video endoscope with a light source is inserted into one puncture, and manipulators into the others. The whole process usually takes 1-2 hours. After that, the patient is sent to the hospital. In the absence of complications, in most cases, the patient is discharged after one or two days.

Laparoscopic cholecystectomy can be done at the DIALINE Surgery Center. The operation is carried out using advanced high-precision equipment, which, combined with the extensive experience of our specialists, allows us to solve the problem quickly and without consequences.

You can make an appointment with a gastroenterologist either on your own in your DIALINE personal account or by ordering a call back.

Do not delay treatment, see a doctor right now:

Gallstone disease – causes, symptoms, diagnosis, complications, treatment of gallstones

Gallstone disease is a chronic disease of the organs of the hepatobiliary system, characterized by a violation of the synthesis and circulation of bile, the formation of stones in the gallbladder or bile ducts. Most often, the pathology is manifested by paroxysmal pain in the right hypochondrium – biliary colic, jaundice. A complete cure is possible only by surgery. Without removal of calculi, the development of severe, including life-threatening, complications is possible – cholecystitis, peritonitis and others.

According to the clinical recommendations of the Russian Federation, the prevalence of gallstone disease in developed countries reaches 10-15%, which is explained by the nature of the diet of their inhabitants. In Africa and Asia, this figure is much lower and is about 3.5-5%. Mostly people aged 40 to 69 are ill. In women, the risk of developing gallstone disease is 2-3 times higher than in men.

Causes

The main cause of stone formation in the gallbladder and ducts is an increased concentration of bile. When it is oversaturated with cholesterol, large calculi of a yellowish-white color are formed. If there is an inflammatory process in the bile ducts, as well as with hemolysis and cirrhosis of the liver, pigmented brown or black stones are formed.

The following factors contribute to the development of gallstone disease:

• genetic predisposition;
• high-calorie diet with excessive intake of fatty foods and simple carbohydrates;
• sedentary lifestyle;
• obesity;
• taking hormonal contraceptives;
• pregnancy;
• rapid weight loss, low-calorie diet;
• helminthiasis;
• alcohol abuse;
• chronic liver pathology, diabetes mellitus, Crohn’s disease, anemia, cystic fibrosis, infectious process in the biliary tract;
• certain medications, eg octreotide, clofibrate.

Symptoms

Pathology for a long time may not have clinical manifestations. Symptoms of gallstone disease appear with inflammation or obstruction in the biliary tract, when stones from the cavity of the gallbladder move into its neck or ducts and clog them. This process may be accompanied by an attack of biliary colic, symptoms of acute calculous cholecystitis, as well as chronic cholecystitis, cholangitis, biliary pancreatitis.

Biliary colic has the following symptoms:

• Severe pain in the projection of the gallbladder. It starts in the right hypochondrium, suddenly and can give in the back, under the right shoulder blade, in the neck, in the right shoulder. In rare cases, its migration to the region of the heart causes angina pectoris. The duration of such an attack in cholelithiasis is from a couple of minutes to several days. The nature of pain is first acute, then constant, aching.
• Taste of bitterness in the mouth, loss of appetite.
• Dyspeptic manifestations. Nausea, vomiting with an admixture of bile, not leading to relief, frequent and loud belching of air or food eaten.
• Increased body temperature. With purulent cholecystitis, fever can reach 39 ° C and above.
• Indigestion. Often the patient has bloating, constipation of the atonic type.

An exacerbation of gallstone disease can be triggered by a violation of the diet. The movement of calculi can also be caused by shaking riding, torso tilts. With the development of choledocholithiasis – the entry of stones into the bile ducts and their blockage – mechanical jaundice develops. With it, the skin, sclera of the eyes and mucous membranes become icteric, there is itching of the skin, darkening of the urine and discoloration of the feces.

Often cholelithiasis appears together with hiatal hernia, peptic ulcer of the stomach or duodenum, diverticulosis of the colon. This is due to the common innervation of the affected organs and similar predisposing factors for these pathologies. In such a situation, the clinical picture of the disease may not be entirely characteristic.

Diagnostics

The diagnosis of gallstone disease is handled by a gastroenterologist, a surgeon, a general practitioner and a general practitioner. In a conversation with the patient, he finds out the duration and nature of the symptoms, the presence of predisposing factors. An important place in the examination is occupied by palpation of the right upper quadrant of the abdomen, during which pain and other characteristic signs of acute cholecystitis are determined: a symptom of Zakharyin, Ortner, Murphy.

Further examination includes the use of laboratory and instrumental methods:
1. Complete blood count. Neutrophilic leukocytosis and accelerated ESR indicate inflammation in the gallbladder – acute cholecystitis.
2. Biochemical blood test. Allows you to identify a typical for cholelithiasis increase in cholesterol and bilirubin, alkaline phosphatase activity. Blockage of the bile ducts and bile stasis often lead to liver damage, so indicators such as alanine aminotransferase, aspartate aminotransferase, gamma-glutamyltranspeptidase, total and C-reactive protein are also important in cholelithiasis.
3. Tumor markers in serum. Their determination is aimed at identifying signs of cancer of the hepatobiliary system.
4. General analysis of urine. Particular attention is paid to the level of bilirubin metabolic products.
5. Ultrasound of the liver and biliary tract. Method of choice in the diagnosis of gallstone disease. During the examination, the so-called “non-functioning” gallbladder can be determined, containing a small amount of bile or, on the contrary, an organ stretched and not contracting in response to choleretic food. There is also severe pain in the right hypochondrium when pressed by the probe (“Murphy’s ultrasound symptom”), the presence of fluid around the gallbladder, thickening of its wall more than 4 mm. Despite the high sensitivity of ultrasound, with choledocholithiasis, it is not sufficiently informative.
6. Plain radiography of the abdominal cavity. The method allows to detect gallstones with a sufficient content of calcium in them and complications of cholelithiasis. The method is also used to recognize emphysematous cholecystitis, porcelain gallbladder, lime bile.
7. X-ray studies with contrast. During execution, a “disabled”, non-staining gallbladder can be determined. Endoscopic retrograde cholangiography is an invasive method that includes cannulation of the major papilla with the introduction of contrast through the choledochus. Percutaneous transhepatic cholangiography is performed if other contrast methods cannot be performed. Oral contrast-enhanced cholecystography and intravenous dye cholangiography are rarely performed.
8. Esophagastroduodenoscopy. A method of visualization of the duodenum with a mandatory examination of the major duodenal papilla.
9. Magnetic resonance cholangiopancreatography. It has high accuracy in detecting small calculi from 2 mm in size, including those in the area of ​​the bile ducts (situations where ultrasound capabilities are insufficient).
10. Endoscopic ultrasound examination of the pancreatic-biliary zone. This study allows you to recognize even very small stones, sludge, strictures of the terminal part of the common bile duct. However, the invasiveness of the procedure and the ability to assess the ductal system only in the area where it enters the duodenum impose restrictions on its implementation.
11. Bilioscintigraphy. This is a radioisotope study with 99mTc labeled iminodiacetic acids. Gallstone disease is indicated by the absence of visualization of the gallbladder, accompanying not only the obstruction of the cystic duct, but also acute or chronic cholecystitis or previous cholecystectomy.

Complications

In cholelithiasis, the walls of organs are traumatized by a stone with the development of inflammation in them, so the pathology can be complicated by cholangitis, cicatricial fusion of the major duodenal papilla, the formation of fistulous tracts between the biliary tract and neighboring organs or the abdominal cavity.

Untimely detection and treatment of acute cholecystitis is dangerous for the development of such fatal complications of cholelithiasis as empyema, gangrene and perforation of the gallbladder, peritonitis.

Treatment

When cholelithiasis is established, the patient is prescribed a diet, he is also recommended lifestyle correction and weight loss. Meals should be frequent and in small portions, with the exception of fried and fatty foods, every 3-4 hours, balanced, contain proteins, carbohydrates, and dietary fiber.

Drug therapy is effective only at the initial stage of gallstone disease, before the formation of calculi. In this case, the treatment is aimed at normalizing the composition of bile and preventing its stagnation. Ursodeoxycholic acid preparations are used, which reduces the saturation of bile with cholesterol and partially extracts it from stones. To alleviate the symptoms of acute calculous cholecystitis, patients are prescribed antispasmodics.