Gallstone disease: diagnosis and treatment

Gallstone disease: diagnosis and treatment.  Photo from www.healthsystem.virginia.edu

Diagnosis and treatment of uncomplicated gallstone disease (GSD) is engaged gastroenterologist. The diagnosis can be established on the basis of complaints the patient and the number of additional studies.

The first patient had an ultrasound of the abdomen. In more severe cases may require X-ray examination with prior administration of a contrast agent (oral or intravenous) — cholecystocholangiography. The contrast agent may also be injected directly into the bile ducts by a special fine-needle puncture (percutaneous cholangiography chrezpechenochnaya) or through an endoscope (endoscopic retrograde cholangiopancreatography, or ERCP). The latter procedure is a bit like a gastroscopy. During ERPHG possible removal of small stones from the bile duct.

Treatment

Treat gallstones can be therapeutically (without surgery) and surgically. Typically, treatment start with therapeutic methods.

  • Diet. Recommended 4-6 a one-time meal with the exception of fatty, fried, spicy, chocolate, carbonated beverages. Forbidden meats, fatty meats (lamb, pork), irritating condiments, alcoholic drinks. Recommended plant foods and dairy products. It is useful to add to food wheat bran.
  • The dissolution of gallstones by special agents (ursodeoxycholic and chenodeoxycholic acids). This method is used only in the case of single small (2 cm) cholesterol (roentgen) of stones, in the absence of contraindications. The course of treatment lasts1-15 years. After several years more than half of patients newly formed stones.
  • Extracorporeal shock wave lithotripsy — the destruction of stones by the shock wave, which is created by special devices. Shown in the case of cholesterol stones up to 3 cm in diameter, the number of no more than 3, with enough gall bladder contractility. The stones are broken into small pieces (size up1-2 mm) and independently out of the body in the feces. The procedure is painless, well tolerated and can be outpatient.

Surgical treatment administered in most cases. It consists in the removal of the gall bladder, which can be done in two ways:

  1. Classical cholecystectomy: During operation do a pretty wide cross-section abdomen. After surgery remains seam length 10-12 see
  2. Laparoscopic cholecystectomy: is performed using special instruments that are introduced into the abdominal cavity through small holes (one centimeter). After surgery marks on the skin are left with. This method has advantages in comparison with classical cholecystectomy: less traumatic requires more short (up to4-5 days) during hospitalization, after it is more rapid recovery and return to normal activities.

Selects the type of surgery, the surgeon depending on the severity of the patient, presence of comorbidities, and other criteria.

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