How do gallstones form in the gallbladder. What are the common symptoms of gallstones. Who is at risk for developing gallstones. How are gallstones diagnosed and treated.

Understanding Gallstones: Formation and Types

Gallstones are solid, pebble-like formations that develop in the gallbladder when bile components harden. These stones can vary in size and composition, typically falling into two main categories:

• Cholesterol stones: The most common type, formed when bile contains excessive cholesterol.
• Pigment stones: Less common, usually developing in people with certain medical conditions.

The presence of gallstones in the gallbladder is known as cholelithiasis, while stones in the bile ducts are referred to as choledocholithiasis. Understanding the distinction is crucial, as the location of the stones can impact symptoms and treatment approaches.

How do gallstones form?

Gallstone formation is a complex process influenced by several factors:

1. Excess cholesterol in bile
2. Imbalance of bile salts
3. Increased bilirubin levels
4. Improper gallbladder emptying

These factors can lead to the crystallization and eventual formation of stones within the gallbladder or bile ducts.

Recognizing Gallstone Symptoms: When to Seek Medical Attention

While many gallstones remain asymptomatic, larger stones or those obstructing bile ducts can cause significant discomfort. Gallstone attacks often occur after consuming fatty meals and during nighttime hours. Common symptoms include:

• Intense, steady pain in the upper abdomen
• Back pain between the shoulder blades
• Right shoulder pain
• Nausea and vomiting
• Fever and chills
• Jaundice (yellowing of skin or eyes)
• Abdominal bloating
• Intolerance to fatty foods
• Indigestion and gas

It’s important to note that these symptoms can mimic other medical conditions, such as heart attacks or appendicitis. Therefore, proper medical evaluation is crucial for an accurate diagnosis.

Are all gallstones symptomatic?

Not all gallstones cause symptoms. Some individuals have “silent stones” that don’t interfere with gallbladder, liver, or pancreatic function. These asymptomatic stones often don’t require treatment unless complications arise.

Risk Factors for Gallstone Development: Who’s Most Susceptible?

Several factors can increase an individual’s likelihood of developing gallstones. Understanding these risk factors can help in prevention and early detection:

• Obesity: Excess weight significantly increases gallstone risk, especially in women.
• Estrogen levels: Pregnancy, hormone replacement therapy, and birth control pills can elevate cholesterol in bile and reduce gallbladder motility.
• Ethnicity: Native Americans have a higher genetic predisposition to gallstone formation.
• Gender: Women are twice as likely as men to develop gallstones.
• Age: Individuals over 60 face a higher risk of gallstone formation.
• Cholesterol-lowering medications: Some drugs can inadvertently increase cholesterol secretion in bile.
• Diabetes: High triglyceride levels associated with diabetes can contribute to gallstone formation.
• Rapid weight loss: Quick fat metabolism can lead to increased cholesterol secretion in bile.
• Fasting: Reduced gallbladder movement during fasting can result in overconcentrated bile.

How does obesity contribute to gallstone formation?

Obesity is a major risk factor for gallstones, particularly in women. Excess weight can lead to increased cholesterol production in the liver, which may result in more cholesterol being excreted into bile. Additionally, obesity can affect gallbladder motility, potentially leading to bile stasis and stone formation.

Diagnostic Approaches for Gallstones: From Ultrasound to Advanced Imaging

Accurate diagnosis of gallstones is essential for appropriate treatment. Healthcare providers employ various diagnostic techniques to detect and evaluate gallstones:

• Ultrasound: A non-invasive imaging technique using high-frequency sound waves to visualize the gallbladder and potential stones.
• Cholecystography: An X-ray procedure that utilizes contrast fluid to assess gallbladder function and detect stones.
• CT scan: Provides detailed cross-sectional images of the abdomen, helpful in identifying gallstones and related complications.
• HIDA scan: A nuclear medicine test that evaluates gallbladder function and can detect blockages in the bile ducts.
• ERCP: A specialized procedure combining endoscopy and X-ray imaging to diagnose and potentially treat gallstone-related issues in the bile ducts.

Why is ultrasound often the first choice for gallstone diagnosis?

Ultrasound is frequently the initial diagnostic tool for gallstones due to its non-invasive nature, lack of radiation exposure, and high accuracy in detecting stones. It provides real-time images of the gallbladder and can often identify even small stones, making it an excellent screening method.

Treatment Options for Gallstones: From Watchful Waiting to Surgery

The treatment approach for gallstones depends on various factors, including the severity of symptoms, stone size, and overall health of the patient. Common treatment options include:

1. Watchful waiting: For asymptomatic stones, regular monitoring may be sufficient.
2. Medications: Certain drugs can help dissolve small cholesterol stones over time.
3. Lithotripsy: Sound waves are used to break up stones, though this method is less common.
4. Cholecystectomy: Surgical removal of the gallbladder, often performed laparoscopically.
5. ERCP: For stones in the bile ducts, this procedure can remove stones during diagnosis.

When is gallbladder removal necessary?

Cholecystectomy, or gallbladder removal, is typically recommended for patients with symptomatic gallstones or those at risk of complications. This surgery is often performed laparoscopically, resulting in shorter recovery times and reduced risk of complications compared to open surgery.

Preventing Gallstones: Lifestyle Changes and Dietary Considerations

While not all gallstones can be prevented, certain lifestyle modifications may help reduce the risk of their formation:

• Maintaining a healthy weight through balanced diet and regular exercise
• Avoiding rapid weight loss and crash diets
• Eating regular meals to promote healthy gallbladder function
• Increasing fiber intake and reducing saturated fats in the diet
• Staying hydrated to help maintain proper bile consistency
• Limiting alcohol consumption
• Discussing medication options with healthcare providers, especially for those at higher risk

How can dietary changes impact gallstone formation?

A balanced diet rich in fiber and low in saturated fats can help prevent gallstone formation. Fiber aids in cholesterol reduction, while limiting saturated fats helps maintain healthy bile composition. Regular meal patterns also promote proper gallbladder contraction and bile flow, reducing the risk of stone formation.

Complications of Untreated Gallstones: Understanding the Risks

If left untreated, gallstones can lead to serious complications, including:

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

These complications can result in severe pain, infection, and in some cases, life-threatening conditions. Prompt medical attention for gallstone symptoms is crucial to prevent these potential complications.

Can gallstones lead to gallbladder cancer?

While rare, there is a slight increased risk of gallbladder cancer in individuals with a history of gallstones. The chronic inflammation and irritation caused by gallstones may contribute to cellular changes that could potentially lead to cancer development. However, it’s important to note that the overall risk remains low, and not all individuals with gallstones will develop cancer.

Living with Gallstones: Management and Quality of Life

For individuals diagnosed with gallstones, especially those opting for watchful waiting or those who have undergone treatment, certain lifestyle adjustments can help manage symptoms and improve quality of life:

• Following a low-fat diet to reduce the likelihood of gallbladder attacks
• Maintaining a healthy weight through proper nutrition and exercise
• Avoiding trigger foods that may cause discomfort
• Taking prescribed medications as directed by healthcare providers
• Attending regular check-ups to monitor gallstone status
• Being aware of potential complication symptoms and seeking prompt medical attention when necessary

How can individuals manage gallstone pain at home?

While severe gallstone pain often requires medical intervention, mild discomfort can sometimes be managed at home. Applying a heating pad to the affected area, practicing relaxation techniques, and avoiding fatty foods may provide temporary relief. However, persistent or worsening pain should always be evaluated by a healthcare professional to prevent potential complications.

Understanding gallstones, their causes, symptoms, and treatment options is crucial for maintaining gallbladder health and overall well-being. By recognizing risk factors and implementing preventive measures, individuals can potentially reduce their likelihood of developing gallstones. For those already diagnosed, working closely with healthcare providers to develop an appropriate management plan is key to minimizing complications and maintaining a good quality of life.

Gallstones | Johns Hopkins Medicine

What are gallstones?

Gallstones form when bile stored in the gallbladder hardens into stone-like
material. Too much cholesterol, bile salts, or bilirubin (bile pigment) can
cause gallstones.

When gallstones are present in the gallbladder itself, it is called
cholelithiasis. When gallstones are present in the bile ducts, it is called
choledocholithiasis. Gallstones that obstruct bile ducts can lead to a
severe or life-threatening infection of the bile ducts, pancreas, or liver.
Bile ducts can also be obstructed by cancer or trauma, but this is not
related to gallstones.

What causes gallstones?

Cholesterol stones are believed to form when bile contains too much
cholesterol, too much bilirubin, not enough bile salts, or when the
gallbladder does not empty as it should for some other reason.

Pigment stones tend to develop in people who have cirrhosis, biliary tract
infections, and hereditary blood disorders such as sickle cell anemia. The
causes of these stones are uncertain.

What are the symptoms of gallstones?

At first, most gallstones do not cause symptoms. However, when gallstones
become larger, or when they begin obstructing bile ducts, symptoms or
“attacks” begin to occur. Attacks of gallstones usually occur after a fatty
meal and at night. The following are the most common symptoms of
gallstones. However, each individual may experience symptoms differently.
Symptoms may include:

• Steady, severe pain in the upper abdomen that increases rapidly and
  may last from 30 minutes to several hours

• Pain in the back between the shoulder blades

• Pain in the right shoulder

• Nausea

• Vomiting

• Fever

• Chills

• Jaundice. A yellowing of the skin or eyes.

• Abdominal bloating

• Intolerance of fatty foods

• Belching or gas

• Indigestion

People who experience the following symptoms should consult their doctor
immediately:

Some people with gallstones do not have any symptoms. These stones are
called “silent stones,” because they do not interfere with the function of
the gallbladder, liver, or pancreas, and do not require treatment in most
cases.

The symptoms of gallstones may resemble other conditions or medical
problems, such as heart attack, appendicitis, ulcers, irritable bowel
syndrome, hiatal hernia, pancreatitis, or hepatitis. Always consult your
health care provider for a diagnosis.

Who is affected by gallstones?

The following are suggested risk factors for gallstones:

• Obesity.
  Obesity is a major risk factor for gallstones, especially in women.

• Estrogen.
  Excess estrogen from pregnancy, hormone replacement therapy, or
  birth control pills appears to increase cholesterol levels in bile
  and decrease gallbladder movement, both of which can lead to
  gallstones.

• Ethnicity.
  Native Americans have the highest rates of gallstones in this
  country and seem to have a genetic predisposition to secrete high
  levels of cholesterol in bile.

• Gender.
  Women are twice as likely to develop gallstones than men.

• Age.
  People over 60 are more likely to develop gallstones than younger
  people.

• Cholesterol-lowering drugs.
  Drugs that lower cholesterol in blood can actually increase the
  amount of cholesterol secreted in bile, which, in turn, increases
  the risk of gallstones.

• Diabetes.
  People with diabetes generally have high levels of fatty acids,
  called triglycerides, which increase the risk for gallstones.

• Rapid weight loss.
  As the body metabolizes fat during rapid weight loss, it causes the
  liver to secrete extra cholesterol into bile, which can cause
  gallstones.

• Fasting.
  Fasting decreases gallbladder movement, which causes the bile to
  become overconcentrated with cholesterol.

How are gallstones diagnosed?

In some cases, asymptomatic gallstones are discovered by
accident–during testing for another diagnosis. However, when pain
persists or happens again and again, your health care provider may want
to conduct a complete medical history and physical examination, in
addition to the following diagnostic procedures for gallstones:

• Ultrasound.
  A diagnostic technique that uses high-frequency sound waves to
  create an image of the internal organs.

• Cholecystography.
  X-ray that shows the flow of contrast fluid through the
  intestines into the gallbladder.

• Blood tests.
  These look for signs of infection, obstruction, jaundice,
  and/or pancreatitis.

• 
  Computed tomography scan (also called a CT or CAT scan).
  
  A diagnostic imaging procedure that uses a combination of
  X-rays and computer technology to produce horizontal, or axial,
  images (often called slices) of the body. A CT scan shows
  detailed images of any part of the body, including the bones,
  muscles, fat, and organs. CT scans are more detailed than
  general X-rays.

• 
  Endoscopic retrograde cholangiopancreatography (ERCP).
  
  A procedure that involves inserting an endoscope (viewing tube)
  through the stomach and into the small intestine. A special dye
  injected during this procedure shows the ducts in the biliary
  system.

• Sphincterotomy.
  Opening the muscle sphincter, a ring of muscle around a natural
  opening that acts like a valve, wide enough so stones can pass
  into the intestine.

Treatment for gallstones

Specific treatment for gallstones will be determined by your health
care provider based on:

• Your age, overall health, and medical history

• Extent of the condition

• Your tolerance of specific medicines, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

If the gallstones cause no symptoms, treatment is usually not
necessary. However, if pain persists, treatment may include:

• Gallbladder removal (cholecystectomy).
  Once removed, the bile flows directly from the liver to the
  small intestine. Side effects of this may include diarrhea
  because the bile is no longer stored in the gallbladder.

• Oral dissolution therapy.
  Drugs made from bile acid are used to dissolve the stones.

• Methyl-tert-butyl ether.
  A solution injected into the gallbladder to dissolve stones.

• Extracorporeal shockwave lithotripsy (ESWL).
  A procedure that uses shock waves to break stones up into tiny
  pieces that can pass through the bile ducts without causing
  blockages.

• Contact dissolution therapy.
  An experimental procedure that involves injecting a drug
  directly into the gallbladder to dissolve the stones.

Picture, Symptoms, Types, Causes, Risks, Treatments

Written by WebMD Editorial Contributors

• What Are Gallstones?
• Gallstone Types
• Symptoms of Gallstones
• Causes of Gallstones
• Gallstone Risk Factors
• Gallstone Diagnosis
• Can Gallstones Go Away on Their Own?
• Gallstone Treatment
• Complications of Gallstones
• Preventing Gallstones
• More

Gallstones are pieces of solid material that form in your gallbladder, a small organ under your liver. If you have them, you might hear your doctor say you have cholelithiasis.

Your gallbladder stores and releases bile, a fluid made in your liver, to help in digestion. Bile also carries wastes like cholesterol and bilirubin, which your body makes when it breaks down red blood cells. These things can form gallstones.

Gallstones can range in size from a grain of sand to a golf ball. You might not know that you have them until they block a bile duct, causing pain that needs treatment right away.

The two main kinds of gallstones are:

• Cholesterol stones. These are usually yellow-green. They’re the most common, making up 80% of gallstones.
• Pigment stones. These are smaller and darker. They’re made of bilirubin.

Gallstones don’t normally cause symptoms. Symptoms occur only when a gallstone gets stuck and blocks the flow of bile through your system.

If you have symptoms, they may include:

• Pain in your upper belly, often on the right, just under your ribs
• Pain in your right shoulder or back
• An upset stomach
• Vomiting
• Other digestive problems, including indigestion, heartburn, and gas

See your doctor or go to the hospital if you have signs of a serious infection or inflammation:

• Belly pain that lasts several hours or is severe
• Fever and chills
• Yellow skin or eyes

Doctors aren’t sure exactly what causes gallstones, but they might happen when:

• There’s too much cholesterol in your bile. Your body needs bile for digestion. It usually dissolves cholesterol. But when it can’t do that, the extra cholesterol might form stones.
• There’s too much bilirubin in your bile. Conditions like cirrhosis, infections, and blood disorders can cause your liver to make too much bilirubin.
• Your gallbladder doesn’t empty all the way. This can make your bile very concentrated.

You’re more likely to get gallstones if you:

• Have a family history of them
• Are a woman
• Are over age 40
• Are of Native American or Mexican descent
• Are obese
• Have a diet high in fat and cholesterol but low in fiber
• Don’t get much exercise
• Use birth control pills or hormone replacement therapy
• Are pregnant
• Have diabetes
• Have an intestinal disease like Crohn’s
• Have hemolytic anemia or cirrhosis of the liver
• Take medicine to lower your cholesterol
• Lose a lot of weight in a short time
• Are fasting

Your doctor will do a physical exam and might order tests including:

Blood tests.  These check for signs of infection or blockage, and rule out other conditions.

Ultrasound. This makes images of the inside of your body.

CT scan. Specialized X-rays let your doctor see inside your body, including your gallbladder.

Magnetic resonance cholangiopancreatography (MRCP). This test uses a magnetic field and pulses of radio waves to make pictures of the inside of your body, including your liver and gallbladder.

Cholescintigraphy (HIDA scan). This test can check whether your gallbladder squeezes correctly. Your doctor injects a harmless radioactive material that makes its way to the organ. A technician can then watch its movement. This can help diagnose cholecystitis (inflammation of the gallbladder) from gallstones.

Endoscopic retrograde cholangiopancreatography (ERCP). Your doctor runs a tube called an endoscope through your mouth down to your small intestine. They inject a dye so they can see your bile ducts on a camera in the endoscope. They can often take out any gallstones that have moved into the ducts, but that’s only done if treatment is planned as part of the procedure since it’s invasive.

Endoscopic ultrasound. This test combines ultrasound and endoscopy to look for gallstones that may be in places that are hard to see with other imaging, such as in the common bile duct as it passes through the pancreas.

If your gallstones aren’t causing symptoms, there’s usually no need for you to have surgery. You’ll only need it if a stone goes into, or blocks, one of your bile ducts. This causes what doctors call a “gallbladder attack.” It’s an intense, knife-like pain in your belly that can last several hours.

If you have sickle cell or another blood disorder, your doctor may consider doing a cholecystectomy as a precaution, even if you don’t have symptoms. 

You don’t need treatment if you don’t have symptoms. Some small gallstones can pass through your body on their own.

Most people with gallstones have their gallbladders taken out. You can still digest food without it. Your doctor will use one of two procedures.

Laparoscopic cholecystectomy. This is the most common surgery for gallstones. The surgeon works through tiny cuts (incisions). They pass a narrow tube called a laparoscope into your belly through a small cut. The tube contains a tiny light and a camera. The doctor will take out your gallbladder through another small cut using special devices. You’ll usually go home the same day.

Open cholecystectomy. Your doctor makes bigger cuts in your belly to remove your gallbladder. You’ll stay in the hospital for a few days afterward. You’ll need open surgery if you have a bleeding disorder. You may also need it if you have severe gallbladder disease, are very overweight, or are in your last trimester of pregnancy.

For both types of surgery,  you’ll get general anesthesia. This means you won’t be awake during the procedure.

If gallstones are in your bile ducts, your doctor may use ERCP to find and remove them before or during surgery.

Nonsurgical treatment: If you have another medical condition and your doctor thinks you shouldn’t have surgery, they might give you medication instead. Chenodiol (Chenodo l) and ursodiol (Actigall, Urso 250, Urso Forte) dissolve cholesterol stones. They can cause mild diarrhea.

You may have to take the medicine for years to totally dissolve the stones, and they may come back after you stop taking it.

Gallstones can cause serious problems, including:

• Gallbladder inflammation (acute cholecystitis). This happens when a stone blocks your gallbladder so it can’t empty. It causes constant pain and fever. Your gallbladder might burst, or rupture, if you don’t get treatment right away.
• Blocked bile ducts. This can cause fever, chills, and yellowing of your skin and eyes (jaundice). If a stone blocks the duct to your pancreas, that organ may become inflamed (pancreatitis).
• Infected bile ducts (acute cholangitis). A blocked duct is more likely to get infected. If the bacteria spread to your bloodstream, they can cause a dangerous condition called sepsis.
• Gallbladder cancer. It’s rare, but gallstones raise your risk of this kind of cancer.

Some lifestyle changes might lower your risk of gallstones.

• Eat a healthy diet that’s high in fiber and good fats, like fish oil and olive oil. Avoid refined carbs, sugar, and unhealthy fats.
• Get regular exercise. Aim for at least 30 minutes, 5 days a week.
• Although obesity is a risk factor, avoid diets that make you lose a lot of weight in a short time.
• If you’re a woman at high risk of gallstones (for example, because of your family history or another health condition), talk to your doctor about whether you should avoid using hormonal birth control.

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Stones in the gallbladder – is it necessary to operate?

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Stones in the gallbladder – is it necessary to operate?

11/28/2018

The formation of stones in the gallbladder is the main symptom of gallstone disease (GSD). In Russia and Europe, this disease is registered in 10-15% of the population. The source of the development of stones are cholesterol, salts and other components of bile, which is formed in the liver and then accumulates in the gallbladder. The formation of gallstones is promoted by stagnation of bile, inflammation in the wall of the gallbladder and ducts, hormonal and metabolic disorders. Sometimes gallstones may not manifest themselves, but most often they cause pain and other concerns. The greatest danger is the complications of gallstone disease.

Why is cholelithiasis dangerous?

– The presence of stones in the gallbladder constantly maintains inflammation in its wall. In the presence of provoking factors – the intake of fatty foods, alcohol, physical activity – the inflammation worsens, and an attack of acute cholecystitis develops, which may require emergency surgery. It is impossible to completely cure chronic cholecystitis in the presence of gallstones.

– The contraction of the gallbladder after a meal can lead to wedging of the stone into the excretory duct of the bladder, as a result of which the gallbladder becomes clogged and creates the effect of a “disabled gallbladder”.

– Small stones can pass from the gallbladder into the bile ducts, causing jaundice and acute pancreatitis. These diseases require emergency surgical treatment and so far often lead to death.

– Large stones can cause bedsores in the wall of the gallbladder. In this case, a fistula usually develops between the gallbladder and the intestines. The constant reflux of intestinal contents into the gallbladder and bile ducts leads to the development of severe inflammation in them.

– With a long course of calculous cholecystitis, chronic pancreatitis inevitably develops. In this case, even the elimination of cholecystitis (removal of the gallbladder) does not give a complete recovery, since pancreatitis continues to cause pain and other complaints.

– Prolonged trauma to the wall of the gallbladder stones in it can lead to the development of gallbladder cancer.

Ways to treat gallstone disease?

The main treatment for gallstone disease is surgery. Methods of dissolution and crushing of gallstones have not justified themselves due to low efficiency, a large number of complications and high cost of treatment.

For more than 100 years, the main operation used for cholelithiasis has been cholecystectomy – the removal of the gallbladder. It does not make sense to remove the stones alone, since the cause of the disease is that the diseased gallbladder forms stones, and it is not the stones that cause gallbladder disease.

Previously, the gallbladder was removed through a large incision in the abdominal wall. Now the “gold standard” in the treatment of cholelithiasis is laparoscopic cholecystectomy, performed through small punctures. The operation takes about an hour. Postoperative hospital stay – 1-2 days. After the operation, it is recommended to limit excessive physical activity and follow a diet for 1-2 months.

Today, laparoscopic cholecystectomy is a fairly safe operation. The complication rate does not exceed 0.1-0.3%, which is lower than in open operations.

What to do if cholelithiasis is detected?

Don’t expect complications! The first step on the road to recovery is to call us and come for a consultation with a surgeon. The specialist of our multidisciplinary clinic will determine the need for surgical treatment and answer all your questions.

To date, only one list of life-threatening complications of cholelithiasis dictates the need for urgent treatment of this disease. It should be recognized as hopelessly outdated recommendations “do not remove stones if they do not bother.”

Learn more about the possibilities of the Center for Minimally Invasive Surgery of the Reaviz multidisciplinary clinic.

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causes, symptoms and treatment at FSCC FMBA

Gallbladder stones: causes, symptoms and treatment at FSCC FMBA

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Stones in the gallbladder (cholelithiasis) – a disease of the gallbladder, which is accompanied by the formation of stones. Stones in the bladder disrupt the process of digestion, interfere with the normal outflow of bile, and cause acute conditions such as colic.

Gallstones are solid masses of various sizes, shaped like rounded stones. They are formed during the hardening of bile, caused by an excess of cholesterol, bile salts, bilirubin.

The gallbladder is a small sac-like organ located under the liver. The main functions are the accumulation and concentration of bile.

In turn, bile is a fluid that is synthesized in the liver. Bile consists of acids, pigments, enzymes. Bile is involved in the breakdown of fats. The liver, gallbladder, duodenum and pancreas are connected by a duct system.

Types of gallstones

• Cholesterol stones. Yellow-green in color. Predominantly formed in women and obese people. The share of cholesterol stones accounts for up to 80%.
• Pigment stones. Black-brown in color. Formed with concomitant diseases of the liver, cirrhosis, inflammation of the bile ducts.

Symptoms

Many people with gallstones do not experience symptoms. Complaints arise during the formation of large stones, an increase in their number, as a result, the development of complications. Complications include inflammation, infection, impaired bile flow after duct closure.

Gallstone colic is a key sign of gallstones. The pain occurs suddenly, quickly reaches a maximum. Colic is characterized by increasing pain in the right hypochondrium. The duration is several hours. Colic is provoked by the intake of fatty foods. Characterized by the following features:

• Sudden, increasing pain in the upper right abdomen
• Severe pain in the center below the sternum
• Right shoulder pain
• Increased pain when eating fatty foods
• Nausea or vomiting
• Fever
• Jaundice
• Discolored chair (clay color)

Causes of cholelithiasis

Responsible for the development of gallstones:

• Increased cholesterol content in bile. High cholesterol levels in the blood lead to high levels of cholesterol in the bile. Excess cholesterol occurs with diabetes, obesity. Lecithin and acids, aimed at dissolving cholesterol, cannot cope with the splitting process. Cholesterol turns into crystals.
• Excess bilirubin. Bilirubin is a breakdown product of red blood cells. An increase in the synthesis of bilirubin is associated with cirrhosis, infection, and blood pathology. Bilirubin as well as cholesterol provokes the formation of stones.
• Impaired contractility of the gallbladder. With incomplete emptying, part of the bile remains in the bladder, concentrates in the form of a precipitate, then crystallizes with the formation of stones

Risk factors:

• Female
• History of cholelithiasis
• Age over 40
• Overweight, obesity
• Metabolic disorders (diabetes mellitus)
• Reduced physical activity
• Unbalanced nutrition
• Pregnancy
• Diseases of the liver

Diagnosis

Diagnosis requires a comprehensive examination. The attending physician conducts a survey, determines the main complaints, the history of the development of symptoms, finds out what provokes the appearance of complaints. Then the doctor conducts an examination, palpates the abdomen in different departments. The survey includes:

• Laboratory tests
• Instrumental diagnostics
• Endoscopic methods

Laboratory tests

If gallstone disease is suspected, a general and biochemical blood test is performed. Assess the performance of the liver and biliary tract.

Instrumental diagnostics

• Ultrasound is a highly effective non-invasive imaging modality. The method is based on the reflection of ultrasonic waves from internal organs and image formation.
• Computed tomography. Allows you to visualize gallstones, as well as complications caused by gallstone disease. The method is based on X-ray radiation.
• Magnetic resonance imaging. Highly informative method in relation to the detailed image of the structures of the liver, gallbladder, biliary tract, as well as inflammation. MRI is based on electromagnetic waves interacting with radio frequency radiation.
• Cholecystography. The patient is injected intravenously with a contrast agent, then an x-ray is taken. The image accurately determines the condition of the biliary tract, the site of obstruction, the presence of inflammation.

Endoscopic methods

• Retrograde cholangiopancreatography is the preferred endoscopic procedure for stone detection. This procedure allows you to remove intraductal stones using a duodenoscope, as well as inject a contrast agent for subsequent x-rays.

Complications

• Cholecystitis is the most common complication. Occurs when a stone enters the cystic duct. Bile, which stagnates in the bladder, causes it to become inflamed. Cholecystitis is accompanied by intense pain, fever.
• Choledocholithiasis is characterized by the movement of a stone into the common bile duct, with an increased risk of damage to both the gallbladder and the liver. Closure of the common bile duct is accompanied by pain, development of obstructive jaundice, infection

Treatment of the gallbladder in the Federal Scientific and Practical Center

Treatment depends on the clinical picture, the intensity of symptoms, concomitant diseases. The goal of treatment is to relieve symptoms, prevent complications and prevent recurrence of the pathology.

Treatment of the gallbladder includes:

• Prescribing drugs
• Surgery
• Extracorporeal lithotripsy
• Endoscopic Stenting
• Lifestyle correction (elimination of excess body weight, proper nutrition)

Medical therapy

Prescribing drugs has two goals: preventing the formation of new and dissolving existing stones. Medicines are effective for small, non-calcified cholesterol stones in a normally functioning gallbladder. The duration of the course is 12 months and longer if necessary.

Laparoscopic surgery

In cholelithiasis, which is accompanied by symptoms, frequent colic, removal of the gallbladder (laparoscopic cholecystectomy) is indicated.

Surgeons of the FSCC FMBA of Russia perform the operation through one access – an advanced type of surgical removal of the gallbladder. The technique consists in creating one incision near the navel, while classical laparoscopy involves four incisions-ports.

Minimally invasive ICG fluorescent navigational laparoscopy is the method of choice for surgical treatment at the Federal Research and Clinical Center. It is based on the use of a fluorescent contrast agent, which is administered intravenously to the patient before surgery. Thanks to the contrast agent, the visualization of anatomical structures, blood vessels, and bile ducts improves. The use of ICG technology has been proven to reduce the risk of intraoperative complications, reduce the patient’s stay in the hospital and the recovery period.

Endoscopic retrocholangiopankeratography (ERCP)

ERCP under the control of the SPY GLASS DC imaging system is a modern method for diagnosing and treating cholelithiasis. The SpyGlass DC device is an ultra-thin endoscope with a miniature camera fixed on it, which is passed through the channel of the main endoscope. An advanced device determines the cause of the disease with high accuracy, allows visually controlled crushing of large stones.

ERCP, along with lithotripsy, is the method of choice in the presence of contraindications to surgical treatment.

Extracorporeal shock wave lithotripsy

Extracorporeal lithotripsy is an alternative to surgery. Under the influence of high-frequency shock waves, stones in the gallbladder can be crushed and destroyed.

Prophylaxis

Following simple recommendations reduces the risk of developing gallstones:

• Regular physical activity
• Maintenance of optimal weight, if overweight, gradual reduction
• Complete, balanced diet, eating at the same time
• Eating high fiber foods

Information verified by an expert

This article is informational and is not intended for self-diagnosis and self-treatment. If signs of discomfort appear, you should contact your doctor.

Before being admitted to our Center, we recommend that you get an online consultation with a doctor without leaving your home. This will help prepare for hospitalization, collect the necessary package of documents. Convenient and fast!

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Endoscopy

Dmitry Sazonov

Head of the Endoscopy Department. Doctor – endoscopist

Experience
over 28 years

Head of Endoscopy Department. Doctor – endoscopist

• Endoscopic diagnosis of the norm and diseases of the respiratory system, gastrointestinal tract, using vital and virtual chromoscopy (NBI, BLI + LCI, FICE, i-Scan)
• Magnifying endoscopy, biopsy (Esophagogastroduodenoscopy, Colonoscopy with examination of the small intestine. Epipharyngolaryngoscopy. Bronchoscopy)
• Surgical endoscopy: endoscopic removal of neoplasms, including large-sized (benign, malignant) organs of the gastrointestinal tract (Polypectomy,

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Experience
over 28 years

Thursday, July 27, 13:30

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Surgery, Liver surgery, Bariatric surgery

Alexander Ivanovich Zlobin

Surgeon

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over 15 years

Surgeon

• Abdominal surgery
• Bariatrics

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over 15 years

Tuesday, August 01, 15:20

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Bariatric surgery

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Surgery, Liver surgery

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Oncosurgery, Surgery, Liver Surgery

Yuri Viktorovich Ivanov

Head of the surgical department.