Cholelithiasis

Gallstone disease (GI) is a disease in which concretions (stones) form in the cavity of the gallbladder or in the bile ducts. Stones are formed as a result of the deposition of bile pigments, cholesterol, certain types of proteins, calcium salts, infection of bile, its stagnation, violation of lipid metabolism.

Causes of gallstone disease:

The main risk factors for developing cholelithiasis include:

• elderly and senile age,
• female gender,
• taking medications that affect the metabolism of cholesterol and bilirubin, 
• heredity, 
• eating disorders (overweight, sudden weight loss, prolonged fasting),
• pregnancy,
• diseases associated with metabolism (diabetes mellitus, metabolic syndrome).

Symptoms.

Patients with cholelithiasis have painful attacks, most often after eating a meal saturated with fat. This can be a single attack or multiple attacks.

Seizures can manifest as:

• Sharp, pronounced pain in the upper abdomen. Pain can occur and disappear, or it can be permanent.
• Dull pain in the right hypochondrium.
• Pain in the back or in the right shoulder blade.
• Nausea, stomach pain, heartburn, or vomiting.
• Decrease or loss of appetite.

Diagnostics.

• Laboratory diagnosis of GI includes a general bloodtest, on the basis of which it is possible to determine the presence of signs of nonspecific inflammation – leukocytosis and a moderate increase in ESR. A biochemical blood test can detect hypercholesterolemia and hyperbilirubinemia, an increase in the activity of liver enzymes. 
• Ultrasound of the abdominal cavity is the most informative method that allows you to determine the presence or absence of concretions in the gallbladder. It also allows you to assess the wall of the gallbladder, and determine the nature of the disease: acute or chronic.
• In more severe cases, an MRI or CT scan of the biliary tract may be necessary. 
• If the presence of concretions in the bile ducts is suspected, ERCP (endoscopic retrograde cholangiopancreatography) is indicated.

Complications of cholelithiasis.

In case of untimely treatment and improper treatment, a number of complications may occur:

• Inflammation of the gallbladder wall (acute cholecystitis), its destruction against the background of inflammation, the development of bile peritonitis.
• Displacement of concretions (stones) from the gallbladder cavity into the lumen of the bile ducts, their obturation (blockage), the development of mechanical jaundice, due to a violation of the outflow of bile.
• Biliary pancreatitis (inflammation of the pancreas against the background of impaired function of the biliary system).
• The development of biliary fistulas (against the background of inflammation of the gallbladder wall, a junction is formed between the wall of the gallbladder and the wall of the hollow organ (most often the duodenum).
• The development of cholangitis (inflammation of the bile ducts).

Treatment.

In the presence of clinical manifestations, removal of the gallbladder is indicated as a source of formation of concretions (stones).
Removal of the gallbladder can be performed from a laparotomic approach( when a large incision is made along the midline of the abdomen or in the right hypochondrium) or from a laparoscopic approach ( 4 small punctures up to 1 cm in size are made on the anterior abdominal wall, special tools are inserted through them and the gallbladder is removed under the control of a video camera).

Laparoscopic access has become the "gold standard" in the treatment of cholelithiasis. This access allows you to minimize postoperative pain, thereby ensuring a rapid recovery of the patient. Patients can be discharged home in the evening of the same day when the operation was performed.

For more information, please contact the staff of the Department of High-tech Surgery or a short-term hospital.