Gallstones Diagnosis, Tests, & Treatments

Written by WebMD Editorial Contributors

• How Do I Know if I Have Gallstones?
• What Are the Treatments for Gallstones?
• Conventional Medicine for Gallstones
• Gallstones and Watchful Waiting
• Nonsurgical Therapy for Gallstones
• Surgery to Remove the Gallbladder
• More

If your symptoms suggest a gallstone problem, your doctor might first examine your skin for jaundice, and then feel your abdomen to check for tenderness. A blood test may reveal evidence of an obstruction.

Because other digestive problems, such as an infection of the duct, can produce symptoms similar to those of a gallstone attack, the doctor may also run other tests to determine if gallstones are in fact the culprit.

The most common technique is an ultrasound exam. This quick, painless procedure uses high-frequency sound waves to create pictures of the gallbladder, bile duct, and their contents. CT scans are also sometimes done to look at the anatomy of your internal organs.

A more complicated test may be used if the doctor suspects that a gallstone is lodged in a bile duct. Commonly known by the acronym ERCP, this test allows the doctor to look at the bile duct through a small flexible tube called an endoscope. The doctor sprays the back of the patient’s throat with an anesthetic drug to prevent gagging, sedates the patient, and passes the endoscope into the mouth, through the stomach, and into the area of the small intestine where the bile duct enters. Dye is injected through the tube and into the bile duct, and then the doctor takes X-rays. Stone removal can be done during this procedure as well. The procedure takes about an hour.

In most cases, treatment of gallstones is considered necessary only if you are having symptoms. Of the various conventional treatments that are available, surgical removal of the gallbladder is the most widely used. Some alternative treatments have also been found to be effective in alleviating the symptoms of troublesome gallstones.

When deciding what course of action to take for symptomatic gallstones, doctors usually choose from among three main treatment options: Watchful waiting, nonsurgical therapy, and surgical removal of the gallbladder.

Though a gallstone episode can be extremely painful or frightening, almost a third to half of all people who experience an attack never have a recurrence. In some cases, the stone dissolves or becomes dislodged and thereby resumes its “silence.” Because the problem may solve itself without intervention, many doctors take a wait-and-see approach following the initial episode.

Even when the patient has had repeated gallstone episodes, the doctor may postpone treatment or surgery because of other health concerns. If your surgery has been delayed, you should remain under a doctor’s care and report any recurrences of gallstone symptoms immediately.

If you are unable or unwilling to go through surgery for a gallstone problem that requires treatment, your doctor may recommend one of several noninvasive techniques. Note that though these methods may destroy symptom-causing gallstones, they can do nothing to prevent others from forming, and recurrence is common.

Some gallstones can be dissolved through the use of a bile salt, although the procedure can be used only with stones formed from cholesterol and not from bile pigments. The drug Actigall (ursodiol) is taken as a tablet; depending on its size, the gallstone may take months or even years to go away. Because some stones are calcified, this treatment often doesn’t work.

Another nonsurgical technique, shock wave therapy, uses high-frequency sound waves to fragment the stones. Bile salt is administered afterward to dissolve small pieces. This therapy is rarely used.

Doctors can also attempt to remove gallstones during an ERCP. During the procedure an instrument is inserted through the endoscope to attempt removal of the stone.

While these therapies may work for some, all of the above nonsurgical therapies are usually unsuccessful long term (since recurrence is common) and are rarely advised in clinical practice.

While the gallbladder serves an important function, it is not essential for a normal, healthy life. When gallstones are persistently troublesome, doctors often recommend removing the organ entirely. This operation is considered among the safest of all surgical procedures. Each year approximately 750,000 Americans have their gallbladder removed. It is also the only treatment method that eliminates the possibility that other gallstones will develop in the future.

When the gallbladder has been removed, bile flows directly from the liver into the small intestine, and this sometimes leads to diarrhea. Because bile no longer accumulates in the gallbladder, quantities of the digestive fluid cannot be stored up and used to break down an especially fatty meal. This condition is not considered serious, however, and can be corrected by simply limiting fat in the diet.

In the past, removal of the gallbladder was done through traditional “open” surgery, which requires surgeons to make a large incision in the abdomen. Patients faced a two- or three-day hospital stay plus several weeks of recovery at home.

Today, however, the most commonly used surgical technique is a much simpler approach known as laparoscopic cholecystectomy. The doctor makes several small incisions in the abdomen, then uses special pencil-thin instruments to remove the gallbladder. A tiny microscope and video camera, snaked through the incision to the site, allow the surgeon to view the operation.

Laparoscopic surgery is highly effective and very safe. It has reduced the hospital stay to a day or two. Patients report less pain and are generally able to resume a normal lifestyle in a short period of time. However, people who are obese or who have a severe infection or inflammation in the gallbladder may still be considered candidates for traditional open surgery.

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Gallstones Picture, Causes, Age, & Symptoms

Written by WebMD Editorial Contributors

• What Causes Gallstones?

Gallstones are crystal-like deposits that develop in the gallbladder — a small, pear-shaped organ that stores bile, a digestive fluid produced by the liver.

These deposits may be as small as a grain of sand or as large as a golf ball; they may be hard or soft, smooth or jagged. You may have several gallstones or just one.

Some 30 million American adults suffer from gallstones. Yet most of those who have the condition do not realize it. In this case, what you don’t know probably won’t hurt you; gallstones that are simply floating around inside the gallbladder generally cause no symptoms and no harm.

These “silent” stones usually go unnoticed unless they show up in an ultrasound exam conducted for some other reason. However, the longer a stone exists in the gallbladder, the more likely it is to become problematic. People who have gallstones without symptoms have 20% chance of having an episode of pain during their lifetime.

When symptoms do occur, it’s usually because the gallstone has moved and become lodged within a duct that carries bile, such as the cystic duct, a small conduit that connects the gallbladder to another tube called the common bile duct. The typical symptom is abdominal pain, perhaps accompanied by nausea, indigestion, or fever. The pain, caused by the gallbladder’s contraction against the lodged stone, generally occurs within an hour of eating a large meal or in the middle of the night. Stones can also clog the common bile duct, which carries bile into the small intestine, and the hepatic ducts, which take bile out of the liver.

Obstructions in the bile pathway may cause a duct to become inflamed and possibly infected. Blockage of the common bile duct, which merges with the pancreatic duct at the small intestine, can also lead to inflammation of the pancreas (gallstone pancreatitis).

In a rare but dangerous condition that occurs most often in older women, gallstones migrate into the small intestine and block the passageway into the large intestine; symptoms include severe and frequent vomiting. Although gallstones are present in about 80% of people with gallbladder cancer, it is uncertain whether gallstones play a role, except when really large stones (greater than 3 centimeters in diameter) are present.

About a million new cases of gallstones are diagnosed in the U.S. each year. For reasons that are still unclear, women are two times more likely than men to be afflicted. Native Americans have the highest rates of gallstones in the U.S. because they have a genetic disposition to secrete high levels of cholesterol in bile (a contributing factor to gallstones.) Mexican-Americans also have high rates of gallstones.

Gallstones are also more common in people over age 60, in those who are obese or have lost a lot of weight in a short amount of time, in those who have diabetes or sickle cell disease, and in women who have had multiple pregnancies and who take hormone replacement therapy or birth control pills.

The primary function of the gallbladder is to store bile, a brown or yellowish fluid that helps the body break down fatty food. When you eat a meal, the gallbladder releases its stored bile into the cystic duct. From there the fluid passes through the common bile duct and into the small intestine to mix with food.

Chief among the ingredients of bile are cholesterol and bile acids. Normally, the concentration of bile acids is high enough to break down the cholesterol in the mixture and keep it in liquid form. However, a diet high in fat can tip this delicate balance, causing the liver to produce more cholesterol than the bile acids are able to handle. As a result, some of this excess cholesterol begins to solidify into crystals, which we call gallstones. About 80% of all gallstones are called cholesterol stones and are created this way. The remaining 20% consist of calcium mixed with the bile pigment bilirubin and are called pigment stones. Sickle cell and other blood disorders where red blood cells are destroyed can often lead to pigment gallstones

Gallstones can form even in people who eat properly. And as researchers have found, a diet extremely low in fat can also contribute to gallstone formation: With little fatty food to digest, the gallbladder is called into play less frequently than usual, so the cholesterol has more time to solidify. Other factors that can reduce activity in the gallbladder, possibly leading to gallstone formation, include cirrhosis, the use of birth control pills or hormone replacement therapy, and pregnancy.

Family history, diabetes, sudden weight loss, and cholesterol drugs, and older age can also increase risk for gallstones.

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Gallstone disease (stones in the gallbladder)

Gallstone disease (cholelithiasis).

Z disease in which the formation and outflow of bile in the biliary system is disturbed, the exchange of cholesterol and bilirubin in the body changes. As a result of these factors, stones (calculi) form in the bile ducts and gallbladder. Gallstone disease is not dangerous in itself, but the possibility of developing severe complications that are likely to be fatal. Much more often, gallstones form in women.

Causes of stone formation

If the balance of bile components in the bile ducts is disturbed, solid formations (flakes) form, which eventually grow and merge into stones. Most often, stones are formed when cholesterol metabolism is disturbed (its excess content in bile). Cholesterol-rich bile is called lithogenic (leading to the formation of stones). Also, infections, inflammation of the organs of the biliary system, allergic reactions, and autoimmune diseases can lead to the development of gallstone disease.

Diagnosis of cholelithiasis

Ultrasound of the abdominal cavity is the most informative method of examination for cholelithiasis. Ultrasound examination accurately shows the presence of echo-impermeable formations – stones, changes in the walls of the bladder. An ultrasound clearly shows the presence of signs of inflammation of the gallbladder. Magnetic resonance and computed tomography of the liver and biliary tract are also used for diagnosis.

Complications of cholelithiasis

The most common complication of cholelithiasis is not just inflammation of the gallbladder (acute and chronic), called cholecystitis, but inflammation with blockage of the bile ducts by a calculus (stone). Blockage of the bile ducts in the pancreas (part of the tract passes through the pancreas) can cause acute pancreatitis. Another common complication of gallstone disease is cholangitis (inflammation of the bile ducts). When the bile ducts are blocked, the patient develops jaundice due to a violation of the outflow of bile pigments, the level of bilirubin in the blood test increases. With inflammation of the ducts and the gallbladder itself, the temperature rises and symptoms of inflammation appear, and with the addition of pathogenic microorganisms, symptoms of purulent inflammation appear. It is these conditions that greatly worsen the prognosis and can cause the most unfavorable outcome.

Treatment of cholelithiasis

If acute or chronic calculous cholecystitis develops, removal of the gallbladder is indicated as a source of stone formation. Surgical intervention is abdominal or laparoscopic, depending on the state of the body, pathological changes in the walls of the bladder and surrounding tissues, and the size of the stones. It is necessary to determine the feasibility of abdominal or laparoscopic intervention with a surgeon. Of course, laparoscopic surgery has a significant cosmetic advantage when there are no large scars left on the abdomen after surgery. But not always (despite modern equipment) it is possible to perform laparoscopic intervention. Therefore, the decision on the type of intervention for the removal of stones must be made in consultation with the surgeon. The surgical department of the Kirov Railway Hospital has accumulated a large successful experience in the removal of gallbladder stones by laparoscopic cholecystectomy.

Prognosis and prevention of cholelithiasis

Prevention of cholelithiasis consists in avoiding factors that contribute to increased cholesterolemia and bilirubinemia, bile stasis. A balanced diet, normalization of body weight, an active lifestyle with regular physical activity can avoid metabolic disorders, and timely detection and treatment of pathologies of the biliary system (dyskinesia, obstruction, inflammatory diseases) can reduce the likelihood of bile stasis and sedimentation in the gallbladder. Particular attention should be paid to the exchange of cholesterol and the state of the biliary system for persons who have a genetic predisposition to stone formation, those whose relatives already suffer from gallstone disease.

In the presence of stones in the gallbladder, prevention of attacks of biliary colic will be following a strict diet (exclusion from the diet of fatty, fried foods, muffins, confectionery creams, sweets, alcohol, carbonated drinks, etc. ), normalization of body weight, consumption of a sufficient amount liquids (water). To reduce the likelihood of movement of calculi from the gallbladder through the ducts, work associated with a long stay in an inclined position is not recommended. Trips (business trips) on rough roads are strictly contraindicated.

The prognosis of the development of cholelithiasis directly depends on the rate of formation of stones, their size and mobility. In the vast majority of cases, the presence of stones in the gallbladder leads to the development of complications. With successful surgical removal of the gallbladder – a cure without pronounced consequences for the quality of life of patients.

Appointment for a consultation with a surgeon and ultrasound examination by phone:

(8332) 25-50-50

Some common misconceptions about gallstone disease

Misconception 1: Gallstones can spontaneously pass from the gallbladder Imagine the structure of bile leg bladder: it has a bottom, a body and a neck. The bubble at the transition to the neck narrows to 7-8 mm. The cervix passes into the cystic duct, which contains a complex valvular apparatus several millimeters in diameter. The neck of the bladder connects with the common bile duct, which then enters the duodenum in the form of a sphincter called the papilla of Vater. The sphincter has the ability to contract, it regulates the flow of bile into the intestines and has a clearance of only 1-1.5 mm! Thus, it is difficult to imagine that stones larger than one millimeter could pass through this powerful valvular apparatus. But they sometimes reach several centimeters in diameter. Most often, stones get stuck in the bile ducts, causing acute cholecystitis, jaundice. Perhaps this misconception is due to the confusion of gallstones and kidney stones. In the urinary system (kidneys), stones can sometimes pass on their own. In the case of the formation of stones in the gallbladder, their independent exit to the outside is unlikely.

Misconception 2: Gallbladder stones can be dissolved with medications and some herbs.

Let’s see what gallstones are. The main chemical compounds that make up their composition are cholesterol, bilirubin, calcium salts, proteins, as well as small amounts of iron, copper, magnesium, sulfur, manganese.

According to the existing classification, stones are divided into cholesterol, complex cholesterol-pigment-salt, pigment. Of all these varieties, only pure cholesterol stones can be dissolved. For this purpose, chenodeoxycholic acid and its preparations are used: chenosan, chenofalk, chenochol, as well as ursodeoxycholic acid and its preparations (ursofalk, ursosan). It should be borne in mind that such treatment is very long, expensive and, unfortunately, does not always lead to the desired results. As for the use of medicinal plants to dissolve stones, they simply do not exist. Phytotherapy (here we also include attempts to be treated with homemade preparations from natural bear bile) aims to improve the chemical composition of bile, accelerate its secretion by the liver, stimulate the emptying of the gallbladder, thereby preventing the formation of stones, but not the removal of stones.

Misconception 3: Stones can be removed from the gallbladder with olive oil

As we have already found out, stones cannot leave the gallbladder. Taking a significant amount of any vegetable oil sharply stimulates bile secretion, contraction of the muscles of the bladder and ducts, as well as the release of pancreatic juice. As a result, it is possible to provoke an exacerbation of chronic cholecystitis, pancreatitis, cause the movement of calculi and infringement of one of them in the neck of the bladder, which leads to the need for urgent surgical treatment.

Delusion 4: If you use olive oil and lemon or apple juice, you can get the desired result.

This “treatment” has a long history. It is known that for the first time vegetable oil (olive or turpentine), alone or in combination with lemon juice, to expel the so-called stones from the gallbladder began to be used by North American healers in the early fifties of the last century. Subsequently, doctors began to use this method. But already in 1891 year, the American doctor Winston in his article showed that the stones found in the feces after taking oil and lemon juice have nothing to do with the gallbladder. Later, scientists found that with the simultaneous ingestion of any of the vegetable oils and acids, in particular lemon juice, special chemical compounds called soaps are formed in the intestines. Passing through the intestines, they acquire a rounded shape. That is why there has been a misconception that softened gallstones come out. Unfortunately, even now you can still find recommendations to use olive oil with lemon juice to remove stones, to lie with your right side on a heating pad. Some so-called folk healers sometimes do it out of ignorance, sometimes deliberately for selfish purposes. Unfortunately, this leads to the opposite goal – the stones do not come out, and the person ends up in the surgical department.

IF STONES ARE ALREADY FORMED, THEN THEY CAN ONLY BE GET RID OF THEM WITH THE HELP OF SURGICAL INTERVENTION. USUALLY IN SUCH CASES, THE GALLBLADER IS REMOVED – CHOLECYSTECTOMY. RECENTLY, LAPAROSCOPIC CHOLECYSTECTOMY IS MORE COMMONLY PERFORMED.

Good to know about laparoscopic cholecystectomy

In order to remove the gallbladder with the formed stones, the surgeon makes 4 punctures of the abdominal wall, each of which requires a miniature skin incision. Unlike the approximately 20 cm incision that is made during open surgery, the 4 punctures in the abdominal wall do not injure muscle tissue, so patients experience much less pain after surgery and can usually return to normal activities within one week. The abdominal wall is punctured with a thin tube called a trocar. Through a trocar inserted in the navel, the surgeon inserts a laparoscope into the abdominal cavity, to which a small video camera and a light source are connected. The video camera transmits the image from the endoscope to a video monitor, and the surgeon can see the organs from inside the body. Trocar punctures are also made at three other points. Through these trocars, the surgeon introduces the special instruments needed to perform the operation. For example, to hold the gallbladder in a fixed position, a gripping clamp is used – a grasper. Instruments that allow the use of a laser beam or a low voltage electric current are used to separate the gallbladder from the liver while sealing the wound surface and stopping bleeding. Ultimately, the gallbladder is removed from the abdominal cavity through a trocar in the navel. The operation is performed under general anesthesia, takes about an hour and requires the patient to stay in the hospital for another 3-6 days, although, of course, in each individual case, these terms are individual.

In the recovery period, immediately after surgery, nausea and discomfort may sometimes occur. In the first week after surgery, a diet with the exclusion of fatty foods is recommended. During the week, you should also be observed by the surgeon. You can return to a full life activity as soon as you feel comfortable.

Appointment for a consultation with a surgeon and ultrasound examination by phone:

(8332) 25-50-50

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causes, symptoms and treatment at FMBA

Gallbladder stones: causes, symptoms and treatment at 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 content of cholesterol 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 the diagnosis and treatment of 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 or 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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Alexander Ivanovich Zlobin

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Dmitry Sazonov

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