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Gallstone disease, or as it is also called, cholecystitis, is a disease associated with a violation in the metabolism of bilirubin and cholesterol. As a result of this, the formation of calculus (stones) in the gallbladder or its ducts occurs. An attack of gallstone disease is one of the most popular diseases after diabetes and cardiovascular pathology.

Gallbladder cholecystitis occurs more often in people in economically developed countries, whose work is associated with a sedentary lifestyle and stressful situations. However, recently, cholelithiasis in children is common.

Formation of stones in the gallbladder

An attack of gallstone disease occurs as a result of the accumulation of bile in the bladder. Through the bile ducts, the movement of bile is ensured by the work of the liver, common bile duct, gallbladder, duodenum and pancreas. This allows bile to enter the intestines in a timely manner during digestion and accumulate in the bladder on an empty stomach.

The reasons for the formation of stones are a change in the composition and stagnation of bile, the onset of inflammatory processes, motor-tonic disorders in the excretion of bile. Signs of gallstone disease are the development of cholesterol (up to 80-90% of all gallstones) mixed and pigment stones. As a result of the appearance of cholesterol stones, there is a supersaturation of bile with cholesterol, its precipitation, and the formation of cholesterol crystals. In case of gallbladder dysmotility, the crystals are no longer able to be excreted from the intestines, remain in it and begin to grow.

Bilirubin (pigment) stones occur during the accelerated breakdown of red blood cells during hemolytic anemia. Mixed stones are a combination of both forms. They contain cholesterol, bilirubin and calcium. Most often, such cholelithiasis, the symptoms of which will be described below, occurs during inflammatory processes in the biliary tract and gallbladder.

Causes of gallstone disease

The reasons for the appearance of stones in women and men are approximately the same. Among the main ones should be highlighted:

• inflammation of the bile ducts (cholecystitis). Infection plays a role in stone formation. Bacteria can convert water-soluble bilirubin into insoluble, which can precipitate;
• cholecystitis occurs as a result of a disruption in the endocrine system: diabetes mellitus, hypothyroidism (insufficient secretion of thyroid hormones), impaired estrogen metabolism in a number of gynecological diseases in women, pregnancy and taking contraceptives. As a result, a violation of the contractile function of the gallbladder and stagnation of bile begins;
• violation of cholesterol metabolism: obesity, gout, atherosclerosis. If cholecystitis begins, ideal conditions are created for the formation of stones;
• hyperbilirubinemia - an increase in the level of bilirubin with an increase in its content in bile - hemolytic anemia;
• the reasons for the formation of stones may lie in a hereditary predisposition;
• in women, gallstones are formed as a result of frequent diets, improper and irregular nutrition;
• excessive consumption of food rich in animal fats and cholesterol. This leads to a shift to the acidic side of the reaction of bile, resulting in cholecystitis and the formation of stones.

Symptoms of gallstone disease

Often cholelithiasis occurs in children, so it is necessary to know not only the causes of its occurrence, but also the first symptoms. Long-term illness may not be accompanied by any symptoms and be a real find on ultrasound. Symptoms begin to appear with the migration of stones, the onset of infection in the gallbladder and ducts. Symptoms of the disease can directly depend on the location of stones, the activity of inflammation, their size, as well as the damage to other digestive organs.

During the release of stones from the gallbladder and their movement through the bile ducts, an attack of biliary colic occurs. If the diet for cholelithiasis is not followed, then this can provoke the movement of stones. The pain is sudden, as if cholecystitis has begun, in the upper abdomen, in the right hypochondrium, gives to the right shoulder and right shoulder blade. Often, the pain is accompanied by nausea, vomiting that is not able to bring relief, dry mouth. The skin may itch.

If you do not start treatment in a timely manner, yellowing of the skin and sclera occurs, the feces become discolored, and the urine, on the contrary, acquires a dark shade. The duration of the pain attack can last from several minutes to several hours, the pain goes away on its own or after taking painkillers.

Symptoms of biliary colic or cholecystitis may not always have standard manifestations, they often resemble other diseases: liver abscess, right-sided pneumonia, acute appendicitis, especially in case of its atypical position, renal colic in acute pancreatitis and urolithiasis. It can manifest itself as cholecystitis, in the form of pain in the heart. In order to make an accurate diagnosis in this case, it is recommended to urgently consult a general practitioner.

Treatment of gallstone disease

There are two ways to treat gallstone disease: conservative and operative.

Medical treatment

Treatment of gallstone disease without surgery is effective if the size of the stones does not exceed 15 millimeters, while maintaining the patency of the cystic duct and the contractility of the gallbladder. True, it is forbidden to treat cholecystitis with medication if:

• the diameter of the stones is more than 2 centimeters;
• acute inflammatory diseases of the biliary tract and gallbladder;
• the causes of the appearance of stones lie in the existing diabetes mellitus, liver disease, chronic pancreatitis, peptic ulcer of the duodenum and stomach;
• if the cause is obesity;
• inflammatory disease of the large and small intestines;
• pregnancy;
• "disabled" - non-functioning gallbladder;
• carbonate or pigment stones;
• gallbladder cancer;
• multiple stones occupying more than half of the volume of the gallbladder.

Methods of treatment with drugs can be as follows. The use of ursodeoxycholic acid preparations, whose action is aimed at dissolving exclusively cholesterol stones. Take the drug from 6 to 24 months. True, after the dissolution of the stones, the probability of recurrence is 50%. The duration of administration and the dose of the drug is determined only by a doctor - a gastroenterologist or therapist. Conservative treatment is allowed only under the supervision of a doctor.

Methods of shock wave cholelithotrepsy - treatment by crushing large stones into small fragments using shock waves, followed by the administration of bile acid preparations. The probability of re-formation of stones is 30%.

For a long time, cholelithiasis can occur with few or no symptoms at all, which creates certain difficulties with its definition in the early stages. This leads to late diagnosis, at the stage of already formed gallstones, when it is very problematic to use conservative methods, and surgical treatment remains the only way to treat.

Surgery

The patient undergoes a planned operation before the onset of the first attack of biliary colic or immediately after it. This is associated with a high risk of complications.

After surgical treatment, it is necessary to adhere to an individual dietary regimen (fractional, frequent meals with the exclusion or restriction of individually intolerant foods, fatty, fried foods). It is necessary to observe the regime of rest and work, physical education. Completely eliminate the consumption of alcohol. Subject to stable remission, spa treatment is possible immediately after the operation.

Treatment with folk remedies

Treatment of gallstone disease with folk remedies is possible at the initial stage, which can only be determined by a doctor. Some of the recipes below are great for getting rid of gallstones.

Chaga treatment

Treatment of gallstone disease with folk remedies is carried out with the help of birch fungus chaga. The recipes for its preparation are simple - a small piece of chaga must be softened by pouring warm water for 3-4 hours. After that, the mushroom should be grated or passed through a meat grinder. The mushroom crushed in this way should be poured with hot water and let it brew for another two days, then strain. Take the infusion up to three times a day, one glass.

Decoction of sunflower root

During treatment with folk remedies for cholelithiasis, a decoction of sunflower root helps well. To do this, clean the root, cutting off all the thread-like processes, cut into small pieces and dry in the shade until completely dry. Next, take three liters of water and pour a glass of dried roots into it. Boil the resulting mass for about 5 minutes.

After cooling the broth, it must be put in the refrigerator. The contents should not be thrown away, because after three days you can use the roots again, filling them with three liters of water. And this time it takes 10 minutes to boil. Drink one liter of decoction every day for two months.

During treatment with sunflower roots, a burning sensation in the joints, an increase in pressure may occur, flakes or sand may appear in the urine. At the same time, treatment should not be stopped, only a slight decrease in dosage is possible.

Dill infusion

A decoction of dill is considered a good remedy in the treatment of gallstones. Take two tablespoons of dill seeds, pour 0.5 liters of boiling water, then boil for 15 minutes over low heat or a water bath. This decoction should be taken 3 times a day for 0.5 cups for three weeks.

Also, in the treatment of gallstone disease, a decoction of horsetail, wheatgrass juice, a decoction of a shepherd's purse, a collection of immortelle, yarrow and rhubarb root, as well as some other herbs are effective.

Complications of gallstone disease

In the case of infection, acute cholecystitis, empyema (large accumulation of pus), cholangitis (inflammation of the bile ducts) develop, which can cause peritonitis. The main symptoms are intense, sharp pain in the right hypochondrium, fever, chills, impaired consciousness, severe weakness. Choledocholithiasis (stones in the bile duct) with the formation of obstructive jaundice. After another attack of biliary colic, yellowness of the skin and sclera, skin itching, darkening of the urine and discoloration of the feces are formed.

With prolonged blockage of the cystic duct and the absence of infection, dropsy of the gallbladder appears. Bile is absorbed from the bladder, but the mucosa continues to produce mucus. The bubble greatly increases in size. Attacks of biliary colic begin, in the future the pain decreases, only heaviness in the right hypochondrium remains.

Against the background of prolonged cholelithiasis, gallbladder cancer often appears, chronic and acute pancreatitis develops. With prolonged blockage of the bile intrahepatic ducts, biliary secondary cirrhosis develops. Large gallbladder stones hardly migrate, but they can cause a fistula between the duodenum and the gallbladder. When a stone falls out of the bladder, its migration begins, which can lead to the development of intestinal obstruction.

The untimely implementation of the operation to remove the gallbladder (cholecystectomy) becomes one of the main causes of the formation of postcholecystectomy syndrome. Complications can pose a threat to human life, and require urgent hospitalization in a surgical hospital.

Prevention of gallstone disease

Even after a successful surgical intervention, the prevention of gallstone disease will not be superfluous. Active rest, classes in the gym, contribute to the rapid outflow of bile, thereby eliminating its stagnation. It is necessary to normalize the total weight, as this reduces the hypersecretion of cholesterol.

Prevention of gallstone disease in patients who must take estrogens, clofibrate, ceftriaxone, octreotide, is to undergo an ultrasound examination. This is necessary to determine changes in the gallbladder. If the level of cholesterol in the blood is elevated, it is necessary to take statins.

Diet for gallstone disease

The diet for cholelithiasis should exclude or limit high-calorie, fatty, cholesterol-rich meals, especially in the case of a hereditary predisposition to the formation of stones.

First of all, there should be frequent meals (4-6 times a day), in small portions, this leads to a decrease in stagnation of bile in the gallbladder. The diet should contain a large amount of dietary fiber, due to fruits and vegetables. You can add bran to the menu (15 grams two to three times a day). This helps to reduce the lithogenicity (tendency to stone formation) of bile.

If you suspect the onset of gallstone disease, it is recommended to immediately consult a doctor. Depending on the stage of the disease, you will be prescribed one of the methods of treatment. In most cases, surgery can be dispensed with.

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Cholelithiasis(cholelithiasis, calculous cholecystitis, cholelithiasis) is a pathological condition characterized by the formation of calculi (stones) in the gallbladder or bile ducts. Most often, overweight women over 40 years of age get sick.

The reasons

Stagnation of bile in the bladder and an increase in the concentration of salts in bile due to metabolic disorders lead to the formation of stones. To provoke the occurrence of pathology can:

Disease classification

Gallstone disease has the following stages of its development:

• Initial (physico-chemical), pre-stone. There are changes in the composition of bile, there are no clinical manifestations of the disease. Pathology can be detected by passing a biochemical analysis of bile;
• Stone formation. The stage also proceeds hidden (asymptomatically), the presence of calculi can be detected during instrumental examinations (ultrasound, CT);
• Clinical manifestations. A form in which there are signs of acute or chronic calculous cholecystitis.

The nature of the stones:

• Cholesterol stones consist only of cholesterol or it is the main component. Stones of large size, white, soft, easily crumble, layered in structure;
• Pigmented (bilirubin) stones are small, brittle, black or brown;
• Mixed calculi are formed from calcium, bilirubin and cholesterol, and can be of different sizes and structures.

Symptoms

At stages 1 and 2 of the formation of cholelithiasis, there are no symptoms, the first warning signs are heaviness in the right hypochondrium, bitterness in the mouth, nausea, and belching.

After the calculus exits the bladder into the bile ducts, the following symptoms occur:

In 1-3% of patients with stones in the bladder, acute calculous cholecystitis is formed.(stones block the channel), the symptoms are somewhat different from gallstone disease:

• The pain syndrome takes on a constant, aching character, intensifies on inspiration;
• Hyperthermia (fever) is observed immediately after the onset of the attack;
• Vomiting can be repeated, does not cause relief.

In chronic cholecystitis, the following symptoms are observed:

• There is nausea, discomfort in the epigastrium after eating;
• Chronic diarrhea (for at least 3 months, daily liquid stools is 4-10 times).

Calculous cholecystitis in children

In children, cholelithiasis, as in adults, is characterized by the appearance of biliary colic, while the pain is localized in the right hypochondrium closer to the midline of the abdomen (a white line visually dividing the abdomen into 2 halves). During an attack, the child rushes about in bed or freezes, afraid to move, takes forced positions (pulls his knees to his stomach, lies on his side). The attack is repeated within 1-2 days.

A child with cholelithiasis also has dyspepsia - nausea, vomiting of bile, fever (up to 38-39), chills, bloating, yellowness of the sclera.

Diagnostics

The clinical diagnosis of cholelithiasis is made on the basis of the patient's complaints, after the appearance of biliary colic, the collection of anamnesis (hereditary factor, past and current diseases), examination of the patient (palpation of the abdomen, examination of the skin), according to the results of laboratory examinations.

Diagnostic research methods:

Treatment Methods

Gallstone disease is treated with drugs, but if there is no improvement, then surgical intervention is used.

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Drug treatment

For the treatment of GSD use the following groups of drugs:

An exemplary dosage regimen:

• Drotaverine 40 mg, adults 40–80 mg, three times a day, children from 3 to 6 years old 40–120 mg in 2–4 doses, 6–18 years old, 80–200 mg in 2–4 doses;
• Kytril 1 mg, adults 1 mg 2 times a day or 2 mg once;
• Remagel suspension 5 ml, consume 1-2 teaspoons, 4 times a day, 30 minutes after meals;
• Venter 1 gr., 0.5-1 gr. 4 times a day or 1 gr., twice a day;
• Ursofalk is prescribed at 10 mg / kg, once a day, for children and adults weighing less than 34 kg, a suspension of 1.25 ml per 5-7 kg is used.

Surgical and instrumental treatment

Diet

Proper nutrition with cholelithiasis ensures stable remission (asymptomatic course) during the course of the disease. With calculous cholecystitis, food is consumed in small portions, 5-6 times throughout the day, at a set time. It is necessary to include a significant amount of animal protein in the diet, it is better to consume dishes warm.

Approved Products:

Foods to be excluded from the diet:

• Vegetables containing essential oils (turnip, onion, radish, garlic) and oxalic acid (sorrel and spinach);
• With obesity, it limits the consumption of pasta, flour. confectionery;
• Fatty meat (lamb, pork), lard;
• Canned food;
• Semi-finished products;
• Margarine, mayonnaise;
• Alcohol.

Complications

In the absence of treatment of gallstone disease, provoke the appearance of the following complications:

• Empyema of the gallbladder (purulent inflammatory process);

With cholelithiasis, a fatal outcome is possible, if symptoms appear, be sure to consult a doctor!

Pericholecystitis (neighboring organs are involved in the inflammatory process);

• Cholangitis (inflammation of the intrahepatic ducts);
• Acute pancreatitis (inflammation of the pancreas);
• Rupture (perforation) of the gallbladder;
• Abscess (abscess);
• Intestinal obstruction;
• Acute peritonitis (inflammation of the peritoneum);
• Fatal outcome.

The benefits of spa treatment

In the chronic course of cholelithiasis, treatment is prescribed in sanatorium-and-spa institutions. This method gives good results and prolongs remission periods. With cholelithiasis, the second and third sanatorium regimen is used, which includes:

• general climatotherapy;
• therapeutic group physical education;
• the use of mineral water;
• balneotherapy (mud therapy has an effective effect);
• various therapeutic baths (mineralized and herbal).

Sanatorium treatment is a mild but effective way of non-surgical treatment of gallstone disease. The results of this treatment are:

• reduction of pain syndromes;
• improvement of general well-being;
• reduction of inflammatory processes of the digestive system, gallbladder;
• stabilization of pancreatic function;
• reduction of lipid oxidation;
• improvement of the intestinal tract;
• change in the density of bile.

This type of treatment is used only in the remission stage and in the absence of pain. Sanatorium-and-spa treatment is not used for acute forms of cholecystitis, especially for purulent ones.

Features of diet therapy

A feature of diet therapy is the regulation of metabolism, especially cholesterol metabolism. To do this, the calorie content is reduced, the consumption of simple carbohydrates and animal fats is limited. Food for cholelithiasis should be simple, balanced and as useful as possible.

The following foods are excluded:

• egg yolk;
• offal;
• fatty meats, fish;
• animal fats.

An exception is butter, it is recommended to use up to 10 gr. in a day. And also forbidden foods include herbs containing a lot of acid - sorrel and spinach. Hot spices, beans, and rich pastries should be avoided. All of these products are difficult to digest and contribute to the exacerbation of the disease.

Changing the diet is the foundation in the treatment of the disease without surgery. According to medical recommendations, use diet number 5.

The main points of the diet are:

• fractional nutrition;
• exclusion of harmful foods;
• the use of foods enriched with magnesium salts.

Portioned food intake improves the functioning of the bile-excretory system.

Nutritionists recommend using different cereals, especially green and ordinary buckwheat, whole grain oatmeal. The diet should contain a sufficient amount of fruits and vegetables, it is recommended to include dairy products. And the consumption of mineral water (alkaline) is an integral part of the therapeutic diet.

Processing of dietary dishes should be carried out in the following ways:

• boiling;
• baking in the oven;
• steam cooking.

First breakfast:

• cottage cheese casserole (120 gr.);
• oatmeal (150 gr.) with butter (10 gr.);
• herbal tea.

Second breakfast - a fruit of your choice (apple, pear, apricot).

• vegetable soup (400 gr.);
• a piece of baked poultry meat;
• steamed vegetables (zucchini, carrots) -120 gr.;
• dried fruits compote.

Snack - fruit compote with crackers.

• fish baked with vegetables (250 gr.);
• a decoction of wild rose and strawberry leaves.

Before going to bed - natural yogurt (200 grams).

Option number 2

First breakfast:

• buckwheat porridge (200 grams);
• natural yogurt with fresh berries (100 grams);
• tea without sugar, you can add honey.

Second breakfast - steamed dried apricots (several pieces).

• boiled veal (100 grams);
• beetroot and carrot salad seasoned with vegetable oil (200 grams);
• herbal tea.

Snack - a baked apple or pumpkin.

• steamed fish cakes (150 gr.);
• boiled rice (100 grams);
• drink with echinacea and rose hips.

Before going to bed - a glass of low-fat yogurt.

Based on this approximate diet menu, it’s easy to pick up dishes, excluding junk food from your diet, and create a list of foods for every day that will meet the No. 5 healing diet.

To understand what diet is necessary for non-surgical treatment of cholelithiasis, it is important to know the features and causes of the disease.

What is gallstone disease

As a result of the failure of metabolic processes in the body, the formation of stones (calculi) occurs, which can be located in the gallbladder or in its ducts.

The provoking factors are:

1. Stagnation of bile, which occurs due to decreased motility and weak contraction of the gallbladder,
2. The composition of bile, which changes as a result of inflammatory diseases and the use of foods rich in cholesterol.

Stones range in size and shape from small crystals to calculi over two centimeters.

Cholelithiasis - diet

The composition of the stones are divided into:

1. Cholesterol - formed when an excess of cholesterol appears in the bile, they are yellow in color and small in size. Characteristic for 90% of people with cholelithiasis.
2. Bilirubin - formed against the background of liver diseases or the destruction of blood cells, have a dark brown color. Can be found in the gallbladder and bile ducts, occur in 5% of patients.
3. Calcium - arise as a result of the action of bacteria that destroy protein, amino acids. A precipitate is formed, consisting of calcium salts. Brown stones, more often located in the biliary tract, occur in 3% of patients.
4. Mixed.

The purpose of treatment with or without surgery will depend on the severity of the disease, the size of the stones and their number in the patient.

Lead to the development of gallstone disease:

• errors in nutrition (lack of diet), non-compliance with the diet, overeating, starvation, the predominance of refined and saturated fat foods in the diet, excessive consumption of alcoholic beverages;
• lack of physical activity, sedentary work;
• congenital disorders of the structure of internal organs, as well as heredity;
• diseases leading to hormonal failure (diabetes mellitus, thyroid disease), pregnancy;
• inflammatory diseases of the internal organs involved in the formation and excretion of bile.

How does cholelithiasis manifest?

During the precipitation of crystals and the initial formation of calculi, cholelithiasis does not manifest itself in any way.

Manifestation of gallstone disease

The first symptoms appear when the formed stones begin to irritate the gallbladder from the inside and prevent the outflow of its contents:

• sudden sharp pain with colic, or aching pain under the ribs, on the right side, which can radiate to the back and shoulder blade, and disappear in a short time;
• feeling of nausea, vomiting (with colic), feeling of bitterness, heartburn;
• flatulence, diarrhea;
• slight rise in temperature

Important to remember! In the absence of treatment, with errors in nutrition (diet), as well as without the necessary operation gallstone disease leads to serious health problems, which may result in death. For example, intestinal obstruction, obstructive jaundice, cirrhosis of the liver, rupture of the bile duct, rupture of the walls of the bladder itself, bleeding, cancer.

How to treat gallstone disease without surgery

Surgical intervention for cholelithiasis is indicated with a large accumulation of stones, or with single stones larger than 2 cm. In this situation, the gallbladder is completely removed, which contributes to recovery in 95% of patients.

In other cases, treatment without surgery is possible:

1. Hardware treatment. With a small number of calculi smaller than 2 cm, it is possible to use ultrasonic or electromagnetic waves. Using appropriate equipment, a shock wave is directed to the stones, which deforms and causes their destruction. The resulting small fragments are excreted in the bile. For the best effect, bile acid preparations are prescribed in parallel. The lithotripsy procedure is painless.
2. Medical treatment. In the presence of cholesterol stones less than 2 cm in size, their dissolution is possible when drugs are taken orally. These include drugs containing ursodeoxycholic and chenodeoxycholic acids. The course of treatment is a year or more. Tablets are taken in a daily dose of 15 mg / kg in 2-3 doses, always according to the doctor's prescription, as they have a number of contraindications.
3. Not medical treatment.

As an additional measure apply treatment with mineral water. It is possible to carry it out at home or in resorts, but as directed by a doctor. Water of low mineralization promotes the formation of bile, improves its composition, lowers cholesterol levels.

Water of medium mineralization has a choleretic effect, which positively affects blood circulation and the functioning of liver cells. The course of treatment is about three weeks.

in the presence of such a disease as cholelithiasis, treatment without surgery is possible, but in this case, the diet is a prerequisite for recovery

Need to take one glass of mineral water three times a day, in the form of heat (42-45°C). With a stomach with low acidity, water is taken 10-20 minutes before meals, with high acidity, it is taken 1.5 hours before meals, with normal acidity, it is taken an hour before meals. Several courses of treatment with mineral-rich water can be carried out per year.

In any case, in the presence of such a disease as cholelithiasis, treatment without surgery is possible, but in this case, diet is a prerequisite for recovery. Mostly appoint table number 5, the doctor can adjust the use of certain products depending on the severity of the disease.

Cholelithiasis. Treatment without surgery with special diets

In the treatment of gallstone disease with a diet need to eat often and in small portions. This technique causes a constant outflow of bile, its stagnation and the formation of new stones are excluded, the symptoms of the disease decrease, and it makes it possible to carry out treatment without surgery.

A diet balanced in fats, proteins and carbohydrates allows you to normalize the composition of bile. An attack of severe pain can cause the intake of too hot or, conversely, too cold food, so it is necessary to take it in a warm, comfortable form for the stomach.

Be sure to chew thoroughly. Avoid late dinner, lack of food in the stomach before bedtime avoids pain. Organize a weekly fasting day. The amount of fluid you drink should be sufficient, about eight glasses a day.

The diet involves the exclusion of the following foods from the diet:

What foods do not harm with cholelithiasis

The cooking methods are boiling, baking, sometimes stewing. The broth for soups should be based on vegetables. Excessive salt intake is unacceptable. Products must be carefully crushed or rubbed.

The diet should contain a variety of cereals

• meat (lean chicken, rabbit, lean beef, etc.),
• lean river fish, squid,
• various cereals (buckwheat, barley, oatmeal, rice, millet),
• black bread (preferably dried), crackers,
• dairy products (cottage cheese, cheese, kefir), butter is limited,
• egg, several times a week,
• various vegetable oils
• vegetables, fruits, dried fruits.
• fruit compotes.

Menu for the day

Note! With the appearance of severe pain, when there is an exacerbation of cholelithiasis, it is recommended to drink water and other liquids for several days. Refusal of food allows the gallbladder to restore its work and rest without load.

The components of the dishes on the menu can be changed, subject to the basic principles of the diet

It is necessary to contact a doctor who will prescribe treatment and exclude the operation. After three days, you can switch to a special sparing diet.

Menu for the day:

• Breakfast. Porridge cooked in milk (semolina, oatmeal or buckwheat), with the addition of olive oil, weak tea (you can use milk).
• Lunch. Dishes made from cottage cheese (for example, pudding), non-acid fruits.
• Dinner. The first is any soup in vegetable broth (pickle, borscht) or milk soup. The second is lean meat (beef stroganoff, meatballs), a vegetable side dish (mashed potatoes, stewed zucchini). The third is dried fruit compote or fruit jelly.
• afternoon tea. Weak tea, lean cookies (biscuits), crackers, bread.
• Dinner. Steamed fish, vegetable cutlets (carrot, carrot-apple), tea.
• Second dinner. A glass of yogurt, it is advisable to drink it two hours before bedtime.

Such food should be kept for a long time, up to two years. The components of the dishes on the menu can be changed, subject to the basic principles of the diet.

Alternative methods of treatment for gallstone disease

The use of folk remedies is an auxiliary method that cannot completely replace therapeutic methods of treatment. The course of taking tinctures and decoctions, to achieve the desired effect, should be long.

Also, the ability to treat gallstone disease without surgery gives a diet and compliance with all doctor's recommendations. Many herbs have a number of contraindications, their use must be approved by a doctor.

Dandelion roots are an excellent choleretic agent

For the preparation of infusions and decoctions, herbs and fees are used that have already proven themselves and give a positive result.

As a diuretic apply a collection of equal parts of chaga and dandelion roots. The components are crushed, then pour two teaspoons of raw materials with boiling water (2 cups). Waiting time is three hours. You need to take it during an exacerbation, half an hour before meals, a day up to four times a tablespoon.

In the chronic course of the disease it is useful to take chaga oil. It is obtained using olive oil. Begin to take half a teaspoon once a day, eventually increasing a single dose to 4 tablespoons. The course of admission is alternated with breaks.

An effective remedy is decoction made from dill seeds. To prepare it, take two tablespoons of raw materials, and pour them with two glasses of water. It is necessary to bring the broth to a boil in a water bath and hold for 15 minutes. After cooling, strain through cheesecloth, apply warm. The course of admission four times a day, for three weeks, half a cup.

This disease can be asymptomatic for a long time.

Sunflower roots are also widely used as a folk remedy.. For a full course of treatment, seven glasses of crushed roots are needed.

First, one glass of prepared roots is boiled for five minutes in three liters of water. The broth is cooled, it should be stored in a cool place, used one liter per day.

Three days later, the roots remaining from the decoction are again boiled in three liters of water, but for ten minutes already. Then after three days they are boiled for twenty minutes. After nine days of intake, sunflower roots are changed to new raw materials. Thus, the treatment takes about two months.

Important to remember! This disease can be asymptomatic for a long time. It can manifest itself unexpectedly with attacks of acute pain, or it is detected during examination of other organs.

In people diagnosed with gallstone disease, treatment without surgery is allowed. Diet, folk remedies and moderate physical activity can cope with the disease, provided it is detected in the early stages.

What foods are prohibited for cholelithiasis, what is possible and what is not allowed, the associate professor tells:

Who is at risk and what gallstone disease can lead to:

Is it possible to get rid of gallstone disease without surgery and what needs to be done for this:

The number and size of gallstones are very diverse: sometimes it is one large stone, but more often - multiple stones, numbering in tens, sometimes hundreds. They range in size from a chicken egg to millet grain and less. Stones may vary in chemical composition. Cholesterol, lime and bile pigments are involved in their formation. Consequently, metabolic disorders in the body, bile stasis and infection play an important role in the process of stone formation. When bile stagnates, its concentration increases, conditions are created for the crystallization of cholesterol contained in it and excreted from the body with it. It has been scientifically established that excessive and irregular nutrition, as well as insufficient mobility, contribute to the creation of conditions for the formation of gallstones. The most common causes of biliary colic (the main manifestation of gallstone disease) are the use of alcohol, spicy fatty foods, and excessive exercise.

A common metabolic disease in which, due to a violation of the processes of bile formation and bile secretion, the formation of stones in the gallbladder occurs. Small stones (microliths) are sometimes also formed in the intrahepatic bile ducts, especially in older men and patients with cirrhosis of the liver. Once in the gallbladder, microliths can serve as a basis for cholesterol to settle on them and form large cholesterol stones. In addition to cholesterol stones, there are pigmented (bilirubin), calcareous, mixed and combined types of stones. Stone carrying is possible without clinical manifestations; often it is accidentally discovered at autopsy. Gallstones occur at any age, and the older the patient, the higher the frequency of the disease. In women, gallstone disease and stone carrying are observed several times more often than in men.

Cholelithiasis is often accompanied by chronic cholecystitis. With multiple stones, bedsores form in the gallbladder, which can lead to ulceration and perforation of its walls.

Classification

• In cholelithiasis, stages are distinguished: physicochemical (changes in bile), latent (asymptomatic stone carrier), clinical (calculous cholecystitis, biliary colic).
• There are the following clinical forms of cholelithiasis: asymptomatic stone carrying, calculous cholecystitis, biliary colic.
• Gallstone disease can be complicated and uncomplicated.

The main manifestation of cholelithiasis is biliary, or hepatic, colic, which is manifested by bouts of very severe pain in the right hypochondrium. At the same time, they spread and give to the right shoulder, arm, collarbone and shoulder blade or to the lower back on the right side of the body. The most severe pain occurs when the blockage of the common bile duct occurs suddenly.

An attack of biliary colic is accompanied by nausea and repeated vomiting with an admixture of bile in the vomit, which does not alleviate the condition of patients. Sometimes there are reflex pains in the region of the heart. Biliary colic usually occurs with an increase in body temperature, which lasts from several hours to 1 day.

Between attacks, patients feel practically healthy, sometimes they feel dull pains, a feeling of heaviness in the right hypochondrium, and nausea. There may be a decrease in appetite, dyspeptic disorders.

With prolonged blockage of the common bile duct, bile from the liver is absorbed into the blood, jaundice occurs, which requires appropriate treatment in a hospital setting.
The most reliable confirmation of the diagnosis of cholelithiasis is the results of an X-ray examination with the introduction of a radiopaque fluid into the bile ducts.

In the clinical manifestations of cholelithiasis, functional disorders of the extrahepatic biliary tract are essential both in the early period before the formation of stones, and in the presence of such. Gallstone disease is quite common, especially in women, a disease accompanied by a number of complications and successive processes.
The size and number of gallstones fluctuate in different cases. The most voluminous are single, solitary stones (monoliths), and the weight of the stone can reach 25-30 g; Gallbladder stones are usually round, ovoid in shape, common bile duct stones resemble the end of a cigar, and intrahepatic duct stones may be branched. Small stones, almost grains of sand, may be among the several thousand in one patient.

The main components of the stones are cholesterol, pigments (bilirubin and its oxidation products) and lime salts. All these substances can be combined in various proportions. From organic substances, they contain a special colloidal substance of a protein nature, which forms the skeleton of a stone, and from inorganic, in addition to lime salts (carbonic and phosphate), iron, copper, magnesium, aluminum and sulfur were found in gallstones. For practical purposes, it is enough to distinguish three types of stones according to their chemical composition: cholesterol, mixed and pigmented.

1. Cholesterol, radiar stones consist almost exclusively (up to 98%) of cholesterol; they are white, sometimes slightly yellowish in color, round or oval in shape, ranging in size from a pea to a large cherry.
2. Mixed stones, cholesterol-pigment-lime, multiple, faceted, found in tens, hundreds, even thousands. These are the most common, most common stones. On the cut, one can clearly see a layered structure with a central core, which is a soft black substance consisting of cholesterol. In the center of mixed stones, fragments of the epithelium, foreign bodies (blood clot, dried roundworm, etc.) are sometimes found, around which stones falling out of bile are layered.
3. Pure pigment stones are of two types: a) observed in cholelithiasis, possibly with plant nutrition, and b) observed in hemolytic jaundice. These pure pigment stones are usually multiple, black in color, turn green when exposed to air; they are found in the bile ducts and in the gallbladder.

Causes of gallstone disease (stones in the gallbladder)

The development of gallstone disease is a complex process associated with metabolic disorders, infection and bile stasis. Undoubtedly, heredity also matters. Metabolic disorders contribute to the violation of bile eicolloidality. The stability of the bile colloid system, its surface activity and solubility depend on the composition and correct ratio of bile ingredients, primarily bile acids and cholesterol (the so-called cholate-cholesterol index). An increase in the concentration of cholesterol or bilirubin in bile can contribute to their loss from solution. The prerequisites for increasing the concentration of cholesterol and reducing the content of cholates in bile are created during stagnation of bile. The infection promotes stone formation by inhibiting the synthesis of bile acids by the liver cells. All these mechanisms, closely related to each other, lead to the development of the disease, which is facilitated by neuro-endocrine and metabolic disorders. Hence the more frequent development of cholelithiasis among people with obesity, an unhealthy lifestyle, its frequent addition to other metabolic diseases (atherosclerosis, diabetes), as well as the frequent occurrence of the disease during repeated pregnancy.

Of great importance in the formation of gallstones is, apparently, an abnormal composition of bile produced by the liver (dyscholia), which contributes to the loss of hardly soluble components of bile, as well as a violation of the general metabolism with an overload of blood with cholesterol (hypercholesterolemia) and other products of slow metabolism. Infection leading to a violation of the integrity of the epithelium of the gallbladder mucosa with its desquamation, foreign bodies inside the gallbladder, easily causing the deposition of lime and other components of bile, are rather only secondary, more rare factors in stone formation. Excessive bile secretion of bilirubin in massive hemolysis is of the same importance.

At the heart of violations of the liver and changes in metabolism are the adverse effects of the external environment in the form of excessive malnutrition, lack of physical work. Of great importance are the neuroendocrine factors that affect the function of the liver cell and tissue metabolism, as well as the emptying of the gallbladder.
Gallstone disease is often combined with obesity, gout, the presence of kidney stones, sand in the urine, atherosclerosis, hypertension, diabetes, that is, it is observed in numerous conditions that occur: with hypercholesterolemia.

The disease most often manifests itself between the ages of 30 and 55, and women are 4-5 times more likely than men. Gallstones with inflammation of the gallbladder and hemolytic jaundice can be observed at an earlier age. Cholelithiasis, of course, often manifests itself clinically for the first time during pregnancy or in the postpartum period: pregnancy is also accompanied under normal conditions by physiological hypercholesterolemia and an increase in liver cell function, which creates the best conditions for fetal development and milk production by the mammary gland. Particularly significant disturbances of metabolic and vegetative processes can be expected in violation of the physiological rhythm of the function of childbearing during repeated abortions or premature births without subsequent lactation, etc., when a delay in the emptying of the gallbladder is also possible due to altered activity of the nervous system. Family cases of gallstone disease, especially frequent in mother and daughter, are most often explained by the influence of the same environmental conditions mentioned above.

It has long been known that foods rich in cholesterol (fatty fish or meat, caviar, brains, butter, sour cream, eggs) contribute to the formation of stones, of course, in violation of oxidative-enzymatic processes.

Experimental studies of recent times have also found the effect of vitamin A deficiency on the integrity of the epithelium of the gallbladder mucosa; its desquamation contributes to the precipitation of salt and other precipitation.

Currently, great importance in the loss of cholesterol in bile is attached, as indicated, to the abnormal chemical composition of bile, in particular, the lack of bile (as well as fatty) acids, which can be seen as a violation of the function of the liver cell itself.

Known value in cholelithiasis have infections and stagnation of bile. Of the transferred diseases, special attention was paid to typhoid fever, since it is known that typhoid bacillus can affect the biliary tract, excreted with bile.

Stagnation of bile contributes, in addition to a sedentary lifestyle, excessive fullness, pregnancy, clothing that compresses the liver or restricts the movement of the diaphragm, prolapse of the abdominal organs, mainly the right kidney and liver; at the same time, an inflection of the bile ducts, especially the cystic one, located in the lig. hepato-duodenale. With swelling of the duodenal mucosa and scarring of ulcerative processes in it, the mouth of the common bile duct can be compressed, which leads to stagnation of bile. Catarrh resulting from a gross violation of the diet sometimes contributes to stagnation of bile and infection of the biliary tract. Usually, however, in addition to the mechanical factor, the action of the above liver-exchange factor is also noted.

The greatest importance in the origin of cholelithiasis should be given to a violation of the nervous regulation of various aspects of the activity of the liver and biliary tract, including the gallbladder, with their complex innervation device. The formation of bile, its entry into the gallbladder and its release into the duodenum is finely regulated by autonomic nerves, as well as by higher nervous activity, for which the great importance of conditioned reflex connections for normal bile secretion speaks.

At the same time, the receptor fields of the biliary tract, already with functional disorders of the biliary function, give rise to pathological signaling to the cerebral cortex. Thus, in the pathogenesis of cholelithiasis, it is possible to establish individual links that are also characteristic of other cortical-visceral diseases.

Exchange-endocrine disorders play only a secondary role, subject to functional changes in the nervous regulation. With an initial lesion of adjacent organs and infectious causes, a violation of the activity of the hepatic-biliary system, leading to cholelithiasis, also occurs in a neuroreflex way.

Separate signs of gallstone disease, especially the signs accompanying biliary colic, characteristic of gallstone dyspepsia, etc., owe their intensity and variety, primarily to the abundant innervation of the gallbladder and biliary tract, and are undoubtedly mainly neuroreflex in nature.

Symptoms, signs of gallstone disease (stones in the gallbladder)

The clinical picture of gallstone disease is extremely diverse and difficult to briefly describe. Uncomplicated cholelithiasis is manifested by cholelithiasis dyspepsia and biliary, or hepatic, colic.

Complications of gallstone disease

Complications of gallstone disease

• biliary colic.
• Cholecystitis.
• Acute pancreatitis.
• Fistula of the gallbladder, mechanical intestinal obstruction.
• Obstructive jaundice.
• Cholangitis and septicemia or liver abscess.
• perforation and peritonitis.

Gallstone disease is characterized by a chronic course, leading to disability of patients and even threatening their lives during certain periods of the disease in the presence of certain complications, especially as a result of blockage of the biliary tract, intestinal obstruction and phlegmonous cholecystitis. Often, the disease takes a latent (latent) course, and stones are found only at the autopsy of patients who died from another cause.

Of the complications of cholelithiasis, almost as numerous as, for example, complications of peptic ulcer of the stomach and duodenum, obstruction of the biliary tract and their infection are described primarily separately, although very often the phenomena of obstruction and infection are combined.

Stones can get stuck in their movement at various points along the path of bile flow, causing special characteristic clinical symptoms. Most often it is necessary to observe blockage of the cystic and common bile duct.

A typical manifestation of the disease is an attack of biliary, or hepatic, colic. The pains come on suddenly, but sometimes they are preceded by nausea. Colic usually begins at night, more often 3-4 hours after an evening meal, especially fatty foods, drinking alcohol; accompanied by a rise in temperature (sometimes with chills), tension in the abdominal muscles, stool retention, bradycardia, vomiting, and bloating. Possible temporary anuria, in the presence of coronary disease - the resumption of anginal attacks. In the duodenal contents, a large number of cholesterol crystals, sometimes small stones are found. In some cases, stones can be found in the stool 2-3 days after the attack. In some cases, colic is repeated often, in others - rarely, proceeding in the form of gallstone dyspepsia.

With biliary colic, complications are possible, of which the most dangerous is blockage of the neck of the gallbladder with a stone; as a result of laying an artificial path to the intestine (fistula) with a stone, a severe infection of the biliary apparatus occurs with the development of abscesses, biliary peritonitis and sepsis in it. Gallstone disease favors the development of malignant neoplasms of the biliary system.

Diagnosis and differential diagnosis of cholelithiasis (gallstones)

The diagnosis of cholelithiasis is made on the basis of complaints of patients, anamnesis and the course of the disease. In the anamnesis, indications of the dependence of complaints on fatty and starchy foods, their connection with pregnancy, the fullness of patients (in the past), the presence of cases of cholelithiasis in the family (in the mother of the patient, sisters) under the same external living conditions are especially important.

When examining patients, the possibility of cholelithiasis is indicated by the presence of at least slight jaundice, skin pigmentation (liver spots, chloasma), cholesterol deposition in the skin (cholesterol nodes - xanthelasmas - in the thickness of the eyelids near the nose). Often, patients have overdeveloped subcutaneous fat. However, cholelithiasis affects, especially in connection with an infection of the biliary tract, also persons with normal and underweight. As a result of the severe course of cholelithiasis, its complications, patients can lose weight dramatically, even acquire a cachectic appearance. The content of cholesterol in the blood may fall below the norm, although often cholelithiasis is accompanied by elevated levels of blood cholesterol. Direct evidence of the presence of a stone can be given by cholecystography, the results of which are positive with modern technology in 90% of patients; detection of microliths in duodenal contents also matters.

As for the differential diagnosis, in various stages of cholelithiasis one has to keep in mind a number of diseases. With gallstone dyspepsia, it is necessary to exclude, first of all, gastric and duodenal ulcers, chronic appendicitis, colitis and many other causes of gastric and intestinal dyspepsia. Erased signs of gallstone dyspepsia, described in detail above, allow clinically clarifying the diagnosis.

Hepatic colic has to be differentiated from a number of diseases.

1. With renal colic, pain is localized below, in the lumbar region, and radiates to the groin, genitals and leg; often there is dysuria, anuria, blood in the urine, and sometimes sand; the vomiting is not so persistent, the febrile reaction is less common. We must not forget that both colic can be observed simultaneously.
2. With food poisoning, the manifestations begin suddenly with profuse food vomiting, often diarrhea, in the form of an outbreak of a number of diseases, there is no characteristic dyspepsia in the anamnesis.
3. In acute appendicitis, pain and tension of the abdominal wall (muscular protection) are localized below the navel, the pulse is more frequent, etc.
4. Duodenal ulcers and periduodenitis, due to their anatomical proximity to the gallbladder, are especially often mixed with biliary colic. A detailed analysis of the pain syndrome, pain points and x-ray examination helps to establish the diagnosis.
5. Myocardial infarction can give a similar picture, especially since the pain and infarction can only be localized in the right upper quadrant of the abdomen ("status gastralgicus" due to acute congestive liver). The history of patients, electrocardiographic changes, etc., resolve the issue. Angina pectoris and even myocardial infarction can be caused by biliary colic. Nitroglycerin, according to some authors, also facilitates an attack of gallstone disease.
6. Acute hemorrhagic pancreatitis is characterized by more pronounced general phenomena (see when describing this form).
7. Intestinal colic is characterized by periodic pain with rumbling and is sometimes accompanied by diarrhea.
8. Mesenteric lymphadenitis (usually tuberculous) when located in the right upper quadrant is sometimes accompanied by pericholecystitis and periduodenitis without affecting the gallbladder itself, but is often mistakenly recognized as chronic cholecystitis.
9. Tabetic crises give less intense pain, vomiting with them is more abundant, the temperature is not elevated, there are neurological signs of dorsal tabes.
10. With lead colic, the pains are localized in the middle of the abdomen, they are spilled, they calm down with deep pressure; the abdomen is usually retracted and tense; blood pressure is increased; the gums have a typical lead border.

As stated above, biliary colic is almost always caused by stones, but in rare cases, it can be caused by ascaris stuck in the ducts or echinococcus bladder. The analysis of feces and the presence of other symptoms of ascaris invasion or echinococcal disease helps to establish the diagnosis.

Enlarged gallbladder with dropsy, it can be mixed with hydronephrosis, pancreatic cyst; the gallbladder is characterized by respiratory mobility and lateral displacement; the anterior echinococcal cyst of the liver is differentiated from hydrocele of the bladder according to the rest of the signs characteristic of echinococcal disease.

It is necessary to differentiate febrile cholecystitis, obstructive stone jaundice, pseudomalarial cholangitis fever, secondary biliary cirrhosis of the liver, gallstone ileus, etc. from other diseases that may resemble the corresponding complication of cholelithiasis along the course.

Forecast and working capacity of cholelithiasis (stones in the gallbladder)

The prognosis of cholelithiasis is difficult to formulate in a general form, the course of the disease is so diverse. In most cases, the disease proceeds with recurrent pain attacks and dyspepsia and, with the right regimen, is not prone to progression and does not significantly shorten life expectancy. Such is the course of cholelithiasis in most sanatorium-and-spa patients. In patients in the therapeutic departments of hospitals, a more persistent course with complications is usually observed; finally, in patients with surgical departments, the most serious complications of cholelithiasis are noted, giving a relatively high mortality rate.

With frequent exacerbations of cholelithiasis and severe inflammatory phenomena (fever, leukocytosis), which are not inferior to treatment, patients are completely disabled or their ability to work is limited. In milder cases of cholelithiasis with a predominance of spastic or dyskinetic phenomena in the gallbladder area, without pronounced symptoms of cholecystitis, patients should be recognized as limited able-bodied in the presence of significant severity and persistence of nervous disorders and frequent, mostly non-infectious, subfebrile condition. They cannot perform work associated with significant physical stress. With the development of severe complications of cholelithiasis, patients are completely disabled.

Prevention and treatment of gallstone disease (stones in the gallbladder)

To relieve a painful attack intravenously, intramuscularly, antispasmodics (drotaverine hydrochloride, papaverine hydrochloride) and analgesics (metamisole sodium, promedol) are administered. If it is still not possible to eliminate the attack and the jaundice does not go away, one has to resort to surgical treatment. To remove stones, lithotripsy is used - their crushing with the help of a shock wave.

Patients with gallstone disease must strictly observe the diet and diet, do not abuse alcohol.

Patients with chronic diseases of the gallbladder and biliary tract with insufficient bile secretion and a tendency to constipation are recommended a diet with a high content of magnesium, calcium, carotene, vitamins B, A. If bile enters the intestine in insufficient quantities, then you should limit the consumption of animal fats. It is also recommended to consume more honey, fruits, berries, raisins, dried apricots.

To prevent the development of an inflammatory process in the mucous membrane of the gallbladder, timely treatment of infectious diseases is necessary. In cases where cholelithiasis is combined with inflammation of the mucous membrane of the gallbladder (chronic cholecystitis), the disease is much more severe. Attacks of biliary colic are more frequent, and most importantly, severe complications (hydrops of the gallbladder, cholangitis, pancreatitis, etc.) can develop, the treatment of which is very difficult.

For the prevention of gallstone disease, a hygienic general regimen, sufficient physical activity and proper nutrition, as well as the fight against infections, disorders of the gastrointestinal tract, elimination of bile stasis, and elimination of nervous shocks are important. For people leading a sedentary lifestyle, it is especially important to avoid overeating, systematically take walks in the fresh air, and play light sports.

Treatment of gallstone disease at various stages of its development is not the same. However, regardless of temporary urgent measures, patients, as a rule, must observe a general and dietary regimen for years and decades, periodically carry out spa treatment in order to counteract metabolic disorders, cholesterolemia, to increase the activity of liver cells, to strengthen the nervous regulation of bile-hepatic activity. Of great importance is the fight against stagnation of bile, infection of the gallbladder and biliary tract, ascending from the intestines or metastasizing from distant foci, as well as eliminating difficult experiences. It is necessary to recommend fractional nutrition (more often and little by little), as it is the best choleretic agent. The daily amount of drinking should be plentiful to increase secretion and dilute bile. It is important to eliminate all causes that contribute to the stagnation of bile (for example, a tight belt); with severe ptosis, wearing a bandage is necessary. Constipation should be controlled by diet, enemas, and mild laxatives.

Dietary nutrition is very important in the treatment of gallstone disease. In acute attacks of biliary colic, a strict sparing regimen is necessary. Concomitant lesions of the gastrointestinal tract or other diseases (colitis, constipation, diabetes, gout) should be taken into account.

In cholelithiasis, it is usually necessary to limit patients both in terms of total caloric intake of food, and in relation to meat, fatty dishes, especially smoked foods, canned food, snacks, and alcoholic beverages. Egg yolks and brains, especially rich in cholesterol, should be excluded from food, and butter should be sharply limited. . The diet should be predominantly vegetarian with a sufficient amount of vitamins, for example, vitamin A, the lack of which in the experiment leads to disruption of the integrity of the epithelium of the mucous membranes and, in particular, to the formation of gallstones. Much attention is paid to the culinary processing of food, and fried meat, strong sauces, broths, and some seasonings should be avoided. It is necessary to take into account not only the physicochemical properties of food, but also its individual tolerance.

During the period of sharp exacerbations of the disease, a meager diet is prescribed: tea, rice and semolina porridge on the water, kissels, white unbread crackers. Only gradually add fruits (lemon, applesauce, compotes), cauliflower, other mashed vegetables, a little milk with tea or coffee, yogurt, low-fat broth or vegetable soup, etc. From fats, fresh butter is allowed in the future in a small amount , with breadcrumbs or vegetable puree; Provence oil is given as a medicine with tablespoons on an empty stomach. Patients for years should avoid those dishes that cause them attacks of colic or dyspepsia, namely: pies, cream cakes and pastries in general, saltwort, pork, fatty fish, cold fatty snacks, especially with alcoholic drinks, etc. .

The regimen of patients with cholelithiasis should not, however, be limited only to a properly selected diet and rational eating habits; patients must avoid excitement, hypothermia, constipation, etc., in a word, all those irritations which, according to their experience, lead with particular constancy to the return of colic, to a large extent, probably due to the zones of prolonged excitation created in the cerebral cortex. The intake of drugs that strengthen the inhibitory process in higher nervous activity, distraction, and similar other methods should be used in order to prevent another attack even when exposed to the usual provoking factors.

In the treatment of cholelithiasis, one of the first places is occupied by sanatorium treatment, which is indicated after the passage of acute attacks (not earlier than 1-2 months) for most patients with uncomplicated cholelithiasis without signs of a pronounced decline in nutrition. Patients are sent mainly to Zheleznovodsk, Essentuki, Borjomi, etc. or to sanatoriums at the place of residence of patients for dietary and physiotherapy. In sanatorium-and-spa treatment, complete rest, proper general regimen, nutrition, measured walks, local application of mud to the liver area, which relieves pain and accelerates the cure of residual inflammatory processes, and drinking mineral waters are beneficial. Of the mineral waters, hot bicarbonate-sulphate-sodium (for example, the Zheleznovodsk Slavyanovsky spring with water at a temperature of 55 °), hydrocarbonate-sodium springs of Borjomi and others are used, which contribute to a better separation of more liquid bile and the cure of gastrointestinal catarrhs, as well as better loosening the intestines and diverting blood from the liver. Mineral or salt-coniferous baths are also used, which act favorably on the nervous system.

Under the influence of climate, mineral waters, hydrotherapy procedures, topical application of mud and, finally, an appropriate dietary regimen, the metabolism changes in a favorable direction, inflammation subsides, bile becomes less viscous and is easier to remove from the biliary tract, and normal nervous regulation is largely restored. activity of the hepatobiliary system.

Of the medicines, bile acids (decholine) can be important, which make it possible to ensure a normal ratio of bile acids and cholesterol and thereby counteract stone formation; herbal preparations rich in anti-spasmodic, anti-inflammatory, laxative ingredients; preparations from plants with choleretic properties (holosas-extract from rose hips, infusion of sandy immortelle-Helichrysum arenarium and many others), choleretic and laxative salts-magnesium sulphate, artificial Carlsbad salt, etc.

Treatment of biliary colic consists in the vigorous application of heat to the area of ​​the liver in the form of heating pads or compresses; if the patient does not tolerate heat, ice is sometimes applied. Assign painkillers: belladonna, morphine. Usually vomiting does not allow oral administration of drugs, and most often it is necessary to inject 0.01 or 0.015 morphine under the skin, preferably with the addition of 0.5 or 1 mg of atropine, since morphine, apparently, can increase spasms of the sphincter of Oddi and thereby increase blood pressure. bile ducts.

Novocaine also relieves colic (intravenous administration of 5 ml of a 0.5% solution), papaverine. Many patients experience bloating during an attack; in these cases, warm enemas are prescribed; with persistent constipation, siphon enemas are used. Vomiting can be soothed by drinking hot black coffee or by swallowing pieces of ice.

Within 5-6 days after the attack, it is necessary to monitor whether the stone is excreted in the stool. In the prevention of a seizure, rest, the prohibition of bumpy driving, an appropriate diet with restriction of fatty and spicy foods, fractional nutrition with sufficient fluid intake and elimination of constipation are important.

In case of infection of the biliary tract, sulfazine and other sulfonamide drugs are used at an average dose, penicillin (200,000-400,000 units per day), hexamine, "non-surgical drainage" of the biliary tract in combination with drugs that increase the body's resistance and improve the condition of the liver: intravenous infusion of glucose, ascorbic acid, campolon, blood transfusion, etc.

With obstructive jaundice, the same drugs are prescribed that improve the condition of the liver, and in addition, ox bile, vitamin K inside parenterally (against hemorrhagic diathesis).
Urgent surgical treatment is indicated for gangrenous cholecystitis, perforated peritonitis, intestinal obstruction on the basis of a stone (simultaneously with treatment with penicillin). Surgical intervention is subject to limited accumulations of pus with empyema of the gallbladder, subdiaphragmatic abscess, purulent cholecystitis, blockage of the common bile duct by a stone, dropsy of the gallbladder, purulent cholangitis. More often, an operation is performed to remove the gallbladder (cholecystectomy) or to open and drain the gallbladder or common bile duct. After the operation, the correct general and dietary regimen is also necessary in order to avoid recurrence of stone formation or inflammatory-dyskinetic phenomena, as well as spa treatment.

In some cases, it should be only conservative, in others, it must be surgical. Foods rich in cholesterol and fats (brains, eggs, fatty meats), rich meat soups, spicy and fatty foods, lard, smoked meats, canned food, rich confectionery, alcoholic beverages should be excluded from nutrition. Allowed dairy products, fruit and vegetable juices, vegetables, vegetarian soups, boiled meat, fish and pasta, cereals, berries, butter and vegetable oil, preferably corn. It is necessary to advise patients to eat moderately, regularly and often, with plenty of drink, giving preference to mineral waters (Essentuki No. 20, Borzhom, etc.).

Assign various choleretic drugs. Karlovy Vary salt, magnesium sulfate, sodium sulfate, allochol, cholecin, cholenzim, oxaphenamide, cholagol, flamin, cholelitin, etc. are very effective. colic sometimes it is necessary to prescribe pantopon or morphine, always with atropine, since morphine preparations can cause spasm of the sphincter of Oddi. In the presence of symptoms of an "acute abdomen", the use of drugs is contraindicated.

In the presence of infection, antibiotics are used, taking into account the sensitivity of the flora isolated from bile, for 5-10 days; sulfa drugs.

Surgical treatment is carried out in cases of a persistent course of the disease, with frequent relapses of biliary colic that occur despite active treatment, with blockage of the gallbladder, perforation of the bladder, and the formation of biliary fistulas. Operative treatment of cholelithiasis should be timely.