What are gallstones and how do they form. What symptoms indicate a gallbladder attack. How are gallstones diagnosed and treated. Can gallstones be prevented through lifestyle changes.

Understanding Gallstones: Formation and Risk Factors

Gallstones are hard deposits that form inside the gallbladder, a small, pear-shaped organ located beneath the liver. These stones can vary in size, ranging from tiny grains of sand to golf ball-sized formations. But how exactly do gallstones develop?

The primary cause of gallstones is an imbalance in the substances that make up bile, a digestive fluid produced by the liver and stored in the gallbladder. Approximately 80% of gallstones are composed of cholesterol. When the liver produces more cholesterol than the bile acids can break down, the excess solidifies, forming stones.

The remaining 20% of gallstones are typically made of bilirubin, a yellowish pigment produced when red blood cells break down. These stones form when there’s an excess of bilirubin in the bile.

Who’s at Risk for Developing Gallstones?

Several factors can increase your likelihood of developing gallstones:

• Gender: Women are more prone to gallstones than men
• Age: Being over 60 years old increases the risk
• Medical conditions: Diabetes can contribute to gallstone formation
• Genetics: A family history of gallstones raises your risk
• Pregnancy and hormonal factors: Pregnancy and birth control pill use can increase the likelihood
• Diet: A high-fat diet may lead to more gallstone formation
• Weight: Being overweight or obese is a significant risk factor
• Rapid weight loss: Low-calorie diets and quick weight loss can trigger gallstone formation

Understanding these risk factors can help individuals take proactive steps to minimize their chances of developing gallstones.

Recognizing the Symptoms of Gallstones

While many people with gallstones never experience symptoms (a condition known as silent gallstones), others may suffer from painful gallbladder attacks. These attacks occur when a gallstone blocks a bile duct, leading to intense discomfort and other symptoms.

What Does a Gallbladder Attack Feel Like?

A typical gallbladder attack may include the following symptoms:

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

These attacks often occur after heavy meals, particularly in the evening or during the night. The pain subsides when the gallstone moves and no longer obstructs the duct. However, if the blockage persists for more than a few hours, complications can arise, necessitating immediate medical attention.

Diagnosing Gallstones: Medical Tests and Procedures

Diagnosing gallstones can be challenging due to the similarity of symptoms with other conditions. Healthcare providers employ a combination of physical examination and medical tests to accurately identify gallstones.

How Do Doctors Diagnose Gallstones?

The diagnostic process typically involves:

1. Physical examination: The doctor checks for signs such as abdominal tenderness and jaundice
2. Blood tests: These can help identify infections or other complications
3. Imaging tests: Ultrasound and CT scans create detailed images of the gallbladder and bile ducts
4. HIDA scan: This nuclear medicine test assesses gallbladder function and bile duct obstruction

In cases where a gallstone is suspected to be lodged in a bile duct, the doctor may recommend an endoscopic retrograde cholangiopancreatography (ERCP) to remove the stone and relieve the blockage.

Treatment Options for Gallstones: From Watchful Waiting to Surgery

The treatment approach for gallstones depends on the severity of symptoms and the results of diagnostic tests. Let’s explore the various options available to patients diagnosed with gallstones.

When Is Surgery Necessary for Gallstones?

For many patients with symptomatic gallstones, surgery is the recommended treatment. Here’s why:

• High recurrence rate: After one gallbladder attack, the chance of having another is up to 70%
• Prevention of complications: Surgery can prevent future attacks and potential complications
• Effective solution: Removal of the gallbladder (cholecystectomy) is a safe and effective treatment

The most common surgical approach is laparoscopic cholecystectomy, a minimally invasive procedure that involves small incisions and typically requires only a short hospital stay.

Are There Non-Surgical Treatments for Gallstones?

For patients who are not suitable candidates for surgery, alternative treatments may be considered:

• Watchful waiting: For those with silent gallstones or mild symptoms, monitoring may be appropriate
• Oral dissolution therapy: Medication to dissolve small cholesterol stones (limited effectiveness)
• Lithotripsy: Sound wave therapy to break up stones (suitable only for specific cases)

It’s important to note that non-surgical treatments often have limitations and may not prevent the recurrence of gallstones.

Preventing Gallstones: Lifestyle Changes and Dietary Considerations

While it’s not always possible to prevent gallstones, certain lifestyle modifications may help reduce the risk of their formation.

Can Diet Influence Gallstone Formation?

Indeed, dietary choices can play a role in gallstone prevention:

• Maintain a healthy weight: Obesity increases the risk of gallstones
• Avoid rapid weight loss: Crash diets can trigger gallstone formation
• Eat a balanced diet: Include plenty of fruits, vegetables, and whole grains
• Limit high-fat foods: Excessive dietary fat can contribute to gallstone development
• Stay hydrated: Adequate fluid intake may help prevent stone formation

Additionally, regular exercise and avoiding long periods of fasting can contribute to overall gallbladder health.

Complications of Untreated Gallstones: When to Seek Medical Help

While some gallstones remain asymptomatic, others can lead to serious complications if left untreated. Understanding these potential issues is crucial for recognizing when to seek medical attention.

What Are the Potential Complications of Gallstones?

Untreated gallstones can lead to several serious conditions:

• Cholecystitis: Inflammation of the gallbladder
• Choledocholithiasis: Blockage of the common bile duct
• Cholangitis: Infection of the bile duct system
• Pancreatitis: Inflammation of the pancreas due to gallstone blockage
• Gallbladder cancer: A rare but serious potential complication

If you experience severe abdominal pain, fever, or jaundice, seek immediate medical attention as these may indicate a gallstone-related complication.

Living Without a Gallbladder: What to Expect After Cholecystectomy

For many patients, gallbladder removal is the most effective treatment for gallstones. But what happens after the surgery? How does the body adapt to life without a gallbladder?

How Does Digestion Change After Gallbladder Removal?

Following a cholecystectomy, most people can return to a normal diet and lifestyle with minimal changes:

• Bile flow: The liver continues to produce bile, which flows directly into the small intestine
• Digestion: Most people experience no significant digestive issues
• Dietary adjustments: Some individuals may need to limit fatty foods initially
• Recovery: Most patients can return to normal activities within a week or two

While some people may experience temporary changes in bowel habits, serious complications from gallbladder removal are rare.

Gallstones in Special Populations: Pregnancy and Older Adults

Certain groups may have unique considerations when it comes to gallstones. Let’s explore how gallstones affect pregnant women and older adults.

How Are Gallstones Managed During Pregnancy?

Pregnancy can increase the risk of gallstone formation due to hormonal changes. Management of gallstones during pregnancy requires careful consideration:

• Conservative treatment: Non-surgical approaches are often preferred when possible
• Timing of surgery: If necessary, surgery is typically safest during the second trimester
• Monitoring: Close follow-up is essential to prevent complications

Each case is unique, and treatment decisions should be made in consultation with both obstetricians and gastroenterologists.

What Challenges Do Older Adults Face with Gallstones?

Older adults may face additional challenges when dealing with gallstones:

• Increased risk: The likelihood of developing gallstones increases with age
• Comorbidities: Other health conditions may complicate treatment options
• Atypical presentation: Symptoms may be less specific in older adults
• Surgical considerations: Age-related factors may influence surgical decisions

Careful evaluation and personalized treatment plans are crucial for managing gallstones in older populations.

As we’ve explored the various aspects of gallstones, from their formation to treatment and prevention, it’s clear that this common condition requires a nuanced approach. While gallstones can cause significant discomfort and potential complications, modern medical interventions offer effective solutions for most patients. By understanding the risk factors and recognizing the symptoms, individuals can take proactive steps to maintain their gallbladder health and seek timely medical attention when needed. Whether through lifestyle modifications, medical management, or surgical intervention, the goal remains the same: to alleviate symptoms and prevent complications, ensuring optimal digestive health and overall well-being.

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

Gallstones – Overview – HSE.

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Gallstones are small stones that form in the gallbladder. They are usually made of cholesterol – a type of fat found in your blood.

Symptoms of gallstones

In most cases, gallstones don’t cause any symptoms and don’t need to be treated.

But a gallstone can become trapped in an opening (duct) inside the gallbladder. This can trigger a sudden, intense pain around your tummy. This pain usually lasts between 1 and 5 hours. It’s known as biliary colic.

Some people with gallstones can also develop complications. These include inflammation of the gallbladder (cholecystitis). This can cause:

• persistent pain
• jaundice
• a fever

When gallstones cause symptoms or complications, it’s known as gallstone disease or cholelithiasis.

Read about the symptoms of gallstones

The gallbladder

The gallbladder is a small, pouch-like organ. It’s found underneath the liver. Its main purpose is to store and concentrate bile.

Bile is a liquid produced by the liver to help digest fats. It’s passed from the liver into the gallbladder through a series of channels. These are known as bile ducts.

Causes of gallstones

Doctors believe that gallstones develop because of a chemical imbalance in the bile inside the gallbladder. In most cases, the levels of cholesterol in the bile become too high. The excess cholesterol then forms into stones.

Gallstones are very common. Around 1 in 10 adults has gallstones. But only a minority of people develop symptoms.

You’re more at risk of developing gallstones if you’re:

• overweight or obese
• female – particularly if you’ve had children
• 40 or over – the risk increases as you get older

Treating gallstones

Treatment is usually only necessary if gallstones are causing:

• symptoms – such as abdominal pain
• complications – such as jaundice or acute pancreatitis

If this is the case, your doctor may recommend keyhole surgery to remove the gallbladder. This procedure is known as a laparoscopic cholecystectomy. It’s relatively simple to perform. There is a low risk of complications.

You can lead a normal life without a gallbladder. Your liver will still produce bile to digest food.

Outlook

You can treat most cases of gallstone disease with surgery. Only very severe cases can be life threatening. This is usually only if you are already in poor health. Deaths from gallstone disease are rare.

Content supplied by the NHS and adapted for Ireland by the HSE

Page last reviewed: 22 December 2020

Next review due: 22 December 2023

This project has received funding from the Government of Ireland’s Sláintecare Integration Fund 2019 under Grant Agreement Number 123.

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. Manifestations of chronic cholecystitis, dyspeptic disorders and indigestion are eliminated with the help of defoamers, prokinetics, probiotics, choleretic, enzyme preparations. Antibacterial agents are also prescribed according to indications.