Красюк Анна Игоревна
Врач терапевт, семейный врач, специалист УЗ-диагностики.

Cholelithiasis

Stagnation in the gallbladder is one of the most common “findings” during ultrasound diagnostics of the abdominal organs.

Chronic cholecystitis develops gradually, the inflammatory process creates conditions for thickening of bile, deposition of cholesterol crystals on the walls of the gallbladder and the formation of stones (gallstone disease).

How do changes occur in the gallbladder?

It should be understood that the revealed changes in the form of “sludge” of bile, “flakes” of bile and calculi in the gallbladder are one and the same stage process of cholelithiasis, where bile conditionally turns from a liquid substance into a liquid with a fine, like sand, undissolved content, further on to a relatively thick medium with an even denser heterogeneous “cloudy” content (like the white of an egg thrown into water), then this content has the ability to thicken, move up to the appearance of dense insoluble “flakes” of bile, over time the “flakes” combine with each other and form stones.

From the appearance of the first changes in the density of bile to stones, it can take more than a decade, and maybe only a few months!

What is the prevalence of changes in the gallbladder?

Stagnant changes in the gallbladder occur in more than 40% of the population, while in women it is 4 times more often than men. It should be noted that women with overweight of more than 10 kg increase the risk of developing gallstone disease by 6 times!

What is the risk factor for the appearance of stagnant changes in the gallbladder?

  • female
  • overweight (10 kg or more)
  • refusal of breakfast
  • irregular food intake
  • large intervals between meals during the day (more than 6 hours)
  • concomitant chronic diseases (caries, tonsillitis, gastritis, duodenitis, pancreatitis, peptic ulcer, cirrhosis of the liver, colitis of various origins, helminthiasis, diabetes mellitus and others)
  • period of pregnancy
  • stressful situations
  • emotional overload

Can housing and communal services be asymptomatic?

In most cases, gallstone disease is asymptomatic and can be an “accidental” ultrasound finding (if the patient is not regularly examined).

It should be understood that if stagnant changes in the bile are already present, this can be regarded as a cholelithiasis (HCS), its initial stage, because a violation of bile metabolism is already present and took a certain time (months, years!) Before the first changes on ultrasound and to the first complaints of the patient, which may not be.

What are the most common symptoms in patients with housing and communal services?

At the beginning of cholelithiasis, when bile has already changed its density, but before the appearance of undissolved elements (calculi), i.e. fatty, fried foods, carbonated drinks, alcohol and can last up to 3 hours.

Moreover, if there are no pebbles yet, but the motility of the gallbladder is reduced (hypokinetic type of gallbladder dysfunction), there is a dull pain in the right hypochondrium, a feeling of pressure and distention, aggravated by tilting the body, nausea, bitterness in the mouth.

If the motility of the gallbladder is enhanced (hyperkinetic type of gallbladder dyskinesia), this is accompanied by a stabbing pain in the right hypochondrium, radiating to the back, under the right scapula, to the right shoulder, less often to the epigastric region, heart, increases with time. The pain is short-term, occurs after a violation of the diet, drinking cold drinks, performing physical activities, stressful situations, sometimes at night.

What are the most common causes of chronic cholecystitis?

Infection (Escherichia coli, Streptococcus, Staphylococcus, less often Proteus, Klebsiela, Enterococcus), which penetrates ascending (from the intestine) by lymphatic or blood vessels from foci of chronic infection (tonsillitis, sinusitis, periodontium).
The development of cholecystitis is caused by intestinal infections with a prolonged course, impaired immunity, as well as factors that disrupt the motility of the gallbladder with its untimely stool and stagnation of bile: irregular food intake, parasitic diseases (giardiasis, ascariasis, opisthorchiasis), obesity.

How often should an ultrasound scan of the gallbladder be performed?

At least once a year if there are no complaints.

If you have complaints with the above symptoms, you should immediately consult a doctor.

Monitor the state of the gallbladder at a frequency that the doctor advises, taking into account changes in it (2-3 times a year).

What are the general guidelines for lifestyle modifications to address or prevent gallbladder changes?

do not skip breakfast (since the “collector” of bile – the gallbladder is as full as possible overnight and should be effectively reduced by a balanced breakfast with a sufficient content of fiber, complex hydrocarbons and high-quality unrefined fats, mainly of vegetable origin: assorted cold-pressed oils, mustard, walnut )
do not make frequent snacks, which can turn into a short-term food intake and will keep blood glucose at a high level and will not allow you to feel physiological hunger, and also does not imply an effective contraction of the gallbladder, because bile will flow from the bile ducts directly into the duodenum, and the collector – the gallbladder will still wait for a full meal, thickening bile and will be practically “turned off” from the digestion process.
add a small amount of fat to each main meal (season vegetables with different oils, because the gallbladder will react more vividly if the range of oils in the daily diet is wider, there are dairy products, poultry, fish
exclude harmful refined fats from the diet and reduce alcohol intake to an acceptable minimum, canned foods, smoked meats, because it is these foods that contribute to fatty degeneration of the liver and increase the density of bile.

What drug treatment is provided for different degrees of housing and communal services?

  • choleretic drugs
  • preparations based on ursodeoxycholic acid
  • proton pump inhibitor drugs
  • prokinetics
  • surgery

 

Frequent exacerbations of chronic cholecystitis can lead to inflammation of the intrahepatic biliary tract (cholangitis), as well as to the inflammatory process of the pancreas (pancreatitis).

That is why a systematic approach and understanding of the relationship between different organs and systems will improve health, quality and life expectancy.

I wish you all health and joy!