Malfunctions of the liver and gallbladder are studied by hepatology. Hepatologists at our clinic treat hepatitis, cirrhosis, cholecystitis, tumor neoplasms, diseases of the biliary tract and much more. The clinic performs a thorough examination to establish an accurate diagnosis, as well as identify the causes of the disease. Next, our qualified doctors select the appropriate treatment method. We use the latest equipment. If you are concerned about hepatological problems, we are guaranteed to help you get rid of them.
Cholelithiasis (GSD)
- a disease caused by impaired metabolism of cholesterol and bilirubin, characterized by the formation of stones in the gall bladder and bile ducts with the possible development of life-threatening complications.
Factors contributing to the formation of cholesterol and mixed gallstones:
- obesity,
- starvation,
- dyshormonal disorders in women associated with pregnancy, taking contraceptive medications,
- diseases of the ileum (Crohn's disease, etc.),
- irrational and unbalanced diet (food rich in fats, insufficient consumption of vegetables and fruits, etc.),
- gallbladder dyskinesia,
- age.
Factors contributing to the formation of pigment stones - black stones consisting of bilirubin and calcium and making up 70% of all radiopaque stones:
- chronic hemolytic anemia,
- alcoholism,
- alcoholic cirrhosis of the liver,
- chronic infections,
- helminth infections of the liver,
- age.
In 10-15% of cases, gallstones are diagnosed during a preventive ultrasound examination of the abdominal organs. The development of cholelithiasis (GSD) goes through several stages.
- first stage - there are no clinical symptoms of the disease, the diagnosis is based on the results of a study of gallbladder bile (the tendency to form stones is determined),
- the second stage is asymptomatic “stone carriage” in which most of the stones located at the bottom of the gallbladder remain asymptomatic,
- the third stage – with a pronounced complicated clinical picture (acute or chronic calculous cholecystitis, etc.).
The manifestations of cholelithiasis depend on the size of the stones, their location and the activity of the inflammatory process, the patency of the biliary system, as well as on the condition of other organs of the gastrointestinal tract.
Why is it important to take care of your liver?
Despite the fact that the liver is quite hardy and capable of self-regeneration, it still requires careful handling. Since regular destruction of organ cells leads to an inflammatory process, tissue scarring and even cirrhosis.
In turn, such conditions reduce the size of the liver, make it dense and change the normal structure. All this leads to disruption of the functioning of the organ, as a result of which the formation of bile worsens, the blood is poorly cleared of toxins and drug residues, and poor digestion of fats is observed.
The destruction of the liver is caused by the consumption of alcoholic beverages, unhealthy diet, viral pathologies and other conditions that provoke damage to its cells. As a rule, various diseases do not cause characteristic symptoms until serious damage to the organ occurs.
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| Biliary (hepatic, biliary) colic. A stone lodged in the neck of the gallbladder closes the exit and causes biliary colic. A stone up to 0.5 cm in size will most likely pass into the lumen of the duodenum; a larger stone may lodge in the common bile duct, which will lead to the development of complete or intermittent obstruction (“valve stone”) with a typical clinical picture of biliary colic. The presence of stones in bile is always accompanied by inflammation (cholangitis). Colic is accompanied by intense short, “minute-long” pain with an interval of up to an hour, long-term recurrent pain in the right hypochondrium is characteristic of chronic cholecystitis. If the pain lasts more than 72 hours and is accompanied by fever, this is most often a sign of acute cholecystitis. Constant pain that continues continuously throughout the day is not typical for biliary colic. The pain is accompanied by flatulence and nausea. Acute cholecystitis. The main cause of the development of the disease is strangulation of a stone in the cystic duct. Characterized by fever and constant pain in the right hypochondrium. Typical pain in acute cholecystitis occurs in less than 50% of patients. Most often, pain occurs soon after eating and increases in intensity over an hour or more. Fever usually appears 12 hours after the onset of the attack and is associated with the development of inflammation. The pain becomes constant. Acalculous acute cholecystitis is extremely rare and can occur secondary to salmonellosis, sepsis and trauma. Complications of acute cholecystitis.
Chronic calculous cholecystitis. Usually characterized by recurrent attacks of biliary colic, less often by constant pain. The development of an attack is provoked by fatty foods, spices, smoked foods, hot seasonings, severe physical stress, working in an inclined position, as well as infection. Less commonly, colic occurs “for no reason.” Usually accompanied by fever, nausea, and sometimes vomiting. The pain intensifies with movement and deep breathing. Sometimes the pain radiates to the heart area, simulating an attack of angina. The pain is varied - from intense cutting to relatively weak aching. Vomiting with cholecystitis does not bring relief. In women, colic sometimes coincides with menstruation or occurs after childbirth. Choledocholithiasis (common bile duct stones) occurs when a stone from the gallbladder enters the common bile duct. Symptoms are characterized by pain in the right hypochondrium similar to biliary colic, fever, chills, jaundice and characteristic changes in blood biochemistry. Cholangitis. A variant of the course of gallstone disease is accompanied by pain in the upper abdomen, jaundice, fever, and often chills. Bacterial cholangitis is one of the most dangerous complications of cholelithiasis; it is usually associated with cholestasis, which occurs when a stone blocks the common bile duct. The severity of cholangitis depends, first of all, on the duration of cholestasis and the level of cholemia. Gangrene and empyema of the gallbladder are manifested by sepsis, a serious condition of the patient with symptoms of peritonitis. Requires immediate medical attention. Empyema is an acute purulent inflammation of the gallbladder, characterized by intoxication and a high risk of perforation. Open perforation into the abdominal cavity is accompanied by peritonitis, causing high mortality (up to 25%). Bile stasis in the gallbladder is hypomotor dyskinesia of the gallbladder. As a rule, it accompanies cholelithiasis. Stasis of bile in the gallbladder is usually manifested by constant dull aching pain in the right hypochondrium, aggravated by shaking, walking quickly, carrying a heavy object in the right hand, or bending forward. It is also observed during pregnancy, long-term use of antispasmodics, after vagotomy, diabetes mellitus, obesity, i.e. for conditions and diseases that are risk factors for the development of cholelithiasis. |
Treatment: surgical. Absolute indications for surgery:
- acute cholecystitis,
- chronic cholecystitis with recurrent biliary colic,
- non-functioning gallbladder,
- common bile duct stones,
- gangrene of the gallbladder.
CHRONIC AALCTIC CHOLECYSTITIS (CAC)
It occurs much less frequently than is diagnosed. If there is a clinical picture of chronic cholecystitis, it is necessary to exclude, first of all, cholelithiasis and parasitic infestations. CBC can be caused by microbial flora. The infection can enter the gallbladder from the gastrointestinal tract through the common bile and cystic ducts (ascending infection). Downward spread of infection from the intrahepatic bile ducts is also possible. The development of the inflammatory process in the gallbladder is promoted by stagnation of bile. CBC is characterized by a long progressive course with periods of remissions and exacerbations, aching pain in the right hypochondrium, less often in the epigastric region, lasting for many hours, days, sometimes weeks. The occurrence or intensification of pain is associated with the consumption of fatty and fried foods, eggs, cold and carbonated drinks, wine, beer, and spicy snacks. The pain may be combined with nausea, belching, bloating, and fever. There is a constant feeling of heaviness in the upper abdomen. Treatment. Diet, fractional meals, pain relief, anti-inflammatory and antiparasitic therapy, taking enzymes.
Treatment technologies
After processing all the data, three options are possible: the doctor will prescribe a special diet for you; will prescribe complex drug treatment to eliminate the causative agent of the disease; or will also prescribe additional treatment, taking into account the existence of other pathologies (diseases of the cardiovascular system, respiratory, urinary, etc.)
Acute diseases of the liver and gallbladder are completely curable in most cases, but chronic diseases are almost impossible to completely cure. During chronic treatment in our clinic, doctors achieve rapid relief of exacerbation, long-term remission, preservation of maximum liver function (that is, compensation for liver failure), and the gall bladder.
Timely diagnosis and prompt initiation of treatment will reduce medical intervention, as well as the consequences of the disease, to a minimum. Contacting a gastroenterologist at our clinic guarantees you qualified diagnostic and therapeutic services. You will be treated according to an individual program.
CHOLESTATIC (subhepatic) JAUNDICE
Cholestatic jaundice develops when there is an obstruction to the flow of bile at any level of the biliary system. Obstructive or subhepatic (obstructive) jaundice develops when bile flow is obstructed at the level of the extrahepatic bile ducts (choledochal stones, pancreatic cancer, chronic pancreatitis, post-traumatic narrowing of the common bile duct, pancreatic pseudocysts, etc.). 70% of cases are associated with stones in the common bile duct and cancer of the head of the pancreas. Intrahepatic cholestasis is most often observed in acute drug-induced hepatitis and primary cirrhosis, less often in viral, alcoholic hepatitis, cholangitis, liver cirrhosis, metastases, etc. Jaundice develops slowly, often preceded by itchy skin. It is typical for both extrahepatic and intrahepatic cholestasis. Diagnostic criteria:
- light-colored (non-pigmented) stools
- dark brown urine
- traces of scratching on the skin,
- yellowish gloss of nails,
- xanthelasma (cholesterol deposits on the eyelids),
- xanthoma (cholesterol deposits on the palmar folds and tendons),
- hepatomegaly – enlargement of the liver.
When blocked by a stone, jaundice develops within 24 hours after the onset of pain, and fever occurs due to developing cholangitis. Itchy skin does not occur in all patients. Unlike a tumor, long-term stone blockage is rarely complete. Diagnostics: Laboratory tests of blood, feces, urine. Instrumental diagnostics: Ultrasound, CT, MRI diagnostics with contrast, Endoscopic diagnostics.
POSTCHOLECYSTECTOMIC SYNDROME
In 15% , pain and dyspeptic disorders remain or recur These symptoms are associated with impaired motility of the sphincter of Oddi, dyskinesia of the extrahepatic bile ducts and duodenum . The main features are:
- recurrent colicky pain in the right hypochondrium,
- fat intolerance,
- diarrhea,
- bloating.
Patients often have duodenogastric reflux, antral gastritis, duodenitis, causing a feeling of heaviness and pain in the epigastrium, nausea, bitterness in the mouth, flatulence, unstable stool, etc. Inflammation of the gastroduodenal mucosa is usually associated with a microbial factor and the damaging effect of bile acids
Symptoms
In the early stages, symptoms of liver disease may be mild. Over time, signs of liver and biliary tract disease become more distinct.
- dyspepsia: nausea, vomiting, diarrhea, constipation, flatulence, belching;
- yellowing of the skin, mucous membranes;
- skin itching;
- fatigue, weakness;
- dark urine and at the same time light feces;
- symmetrical red spots on the palms;
- sometimes - an increase in temperature;
- heaviness in the epigastric region, right hypochondrium;
- swelling of the legs;
- increase in abdominal size (ascites);
- drowsiness during the day, insomnia at night;
- the appearance of spider veins;
- weight loss, loss of appetite.
If these symptoms occur, you should consult a gastroenterologist-hepatologist!
