What are the symptoms of diseases of the gall?a bubble?

Update: December 2018

The gall bladder, given its small size, is enough
important organ of the digestive system. It is a container for
incoming bile into it, secreting it into the intestinal lumen.

Resorption (reabsorption) in
blood protein, important salts, amino acids, mucus and special secretions
hormone – anticholecystokinin. The gallbladder can hold approximately
50 ml of liquid.

Bile is formed in the cells of the liver, then by special bile
ducts that form a complex network enters the gall
a bubble where it is stored until a person eats. After that,
as food enters the duodenum, a reduction occurs
gallbladder, and bile, along with pancreatic juice moves in
intestines.

A healthy person can form from 500 to 1000 per day.
ml of bile. Its composition is quite diverse: water, bile acids,
inorganic substances, vitamins A, B, C, D, amino acids,
phospholipids, cholesterol, bilirubin, proteins, mucus and residues
drugs.

Functions of bile are quite diverse:

  • neutralizes gastric juice
  • activates intestinal and pancreatic enzymes
  • interferes with the growth of harmful bacteria in the intestines
  • improves intestinal motility
  • removes toxic substances and drugs.

Characteristics of the main pathologies of the gallbladder

Cholelithiasis

It is a disease of the biliary system that is associated with a disorder.
bilirubin metabolism and cholesterol, characterized by the formation of
stones inside the liver, in the common bile duct and in the gallbladder.
There are 5F criteria for people most susceptible to the emergence of GIB

  • Female – women
  • Fat – overweight
  • Fair – blonde
  • Forties – over 40 years old
  • Fertile – giving birth

According to the mechanism of formation, there are 3 types of stones: cholesterol,
пигментные  билирубиновые коричневые и черные.

Cholelithiasis может протекать длительное время
asymptomatic, and clinically manifest in the form of an attack of “hepatic
colic “when the stone gets into the narrow bile duct.

Chronic stoneless cholecystitis

This is a long inflammatory process that affects the internal
shell of the bubble and not accompanied by the formation of stones. Main
causes of disease:

  • bacterial infection – intestinal microflora (intestinal
    sticks, enterococcus), staphylococci and streptococci, proteus, sticks
    typhoid and paratyphoid fever, anaerobic microflora;
  • parasitic invasion – feline flute, Giardia,
    roundworm;
  • return bile from the intestines – dangerous in it
    pancreatic enzymes that, when entering the bladder,
    begin to digest its wall; This pathology is also called
    chemical cholecystitis;
  • аллергии – пищевые  и аэрогенные аллергены;
  • inflammatory diseases of the digestive system – especially
    Hepatitis and pancreatitis adversely affect;
  • bile stasis.

Biliary dyskinesia

It is a functional disease of the biliary tract associated with
a change in the tone of the gallbladder or ducts, accompanied by
recurrent pain in the right hypochondrium and dyspeptic
frustrations.

This pathology usually occurs with constant stress,
psycho-emotional stress, neurosis. Depending on the change
tonus of a bubble allocate hyperkinetic (or painful) and
hypokinetic (dyspeptic) types of the disease.

Acute cholangitis

This is an acute inflammatory process that affects the biliary.
ducts. It usually occurs as a complication of chronic cholecystitis,
JCB or after removal of the gallbladder. Infection development
contributes to the stagnation of bile, squeezing ducts tumors, stones.
There are obstructive, recurrent, bacterial, secondary
sclerosing cholangitis.

Gallbladder cancer

In most cases, cancer is the outcome of chronic inflammatory
process in the body. Allocate: adenocarcinoma, mucous, solid and
squamous cell carcinoma. Gallbladder cancer is characterized by high
malignancy, early metastasis and germination in neighboring
organs.

 Main симптомы

Symptom Cholelithiasis (приступ печеночной колики) Chronic cholecystitis Biliary dyskinesia Acute cholangitis Gallbladder cancer
Pain description Acute paroxysmal pain after dietary disturbances; sick
is on the right side with legs pressed to the chest, any movement
only intensifies the pain.
Most patients suffer from a feeling of heaviness, constant aching
pains worse after eating fatty, spicy foods,
carbonated drinks, alcohol
Hyperkinetic type: acute short-term paroxysmal
pain lasting up to 20 minutes. Hypokinetic type: blunt,
aching, arching pains, feeling of heaviness in the right side
Acute paroxysmal intolerable pain until the fall
blood pressure
For a long time may not cause pain, then
dull pains badly stopped by analgesics appear
Localization of pain In the right side In the right hypochondrium, sometimes in the pit of the stomach In the right side
Irradiation of pain In the right shoulder, shoulder blade, collarbone, back, left half
torso
In the right shoulder, лопатку, ключицу In the right shoulder, shoulder blade, collarbone, back, left half
torso
In the right shoulder, shoulder blade, collarbone, back, left half
torso
In the right shoulder, лопатку, ключицу
Dyspepsia Repeated vomiting without nausea Nausea, vomiting with admixture of bile, bitterness during
mouth, burping bitter, heartburn, loss of appetite, diarrhea,
flatulence
Hyperkinetic type: nausea, vomiting. Hypokinetic type:
nausea, vomiting, stool trouble
Repeated vomiting without nausea Rapid weight loss, aversion to food, constant nausea,
recurrent vomiting episodes
Pruritus Is characteristic Not typical Is characteristic Not typical
Fever, chills High fever up to 40º C, accompanied by chills,
torrential sweats
Irregular symptom, observed in 40% of patients Low fever High fever up to 40º C, accompanied by chills,
torrential sweats
Low fever
Symptoms of peritoneal irritation Sharply expressed in the right side Slight strain of the abdominal muscles in the right hypochondrium Pronounced in the right hypochondrium Slight tension of the abdominal muscles in the right side

 Diagnosis of gallbladder disease

Painful symptoms of gallbladder pathology:

  • point Kerra – the point of projection of the gallbladder to the front
    abdominal wall – located at the intersection of the right edge of the rectus muscle
    the abdomen with the right costal arch;
  • Symptom of Georgievsky-Mussi – pain with pressure between
    legs of the sternocleidomastoid muscle on the right (guide
    is the inner edge of the right clavicle);
  • symptom Ortner-Grekov – the occurrence of pain in
    right side when tapping the edge of the palm on the edge of the costal
    arc.

Changes in laboratory parameters for diseases
biliary system

Indicator Norm What does it say What diseases indicates
Increased total bilirubin due to unbound
  • Norm total bilirubin – 8.5-20.8 µmol / l
  • indirect bilirubin – 1.7-17.1 mol / l
More often indicates a violation of the outflow of bile (mechanical
jaundice)
Cholelithiasis, рак gallbladder, общего желчного
duct, Vater papilla, acute cholangitis, chronic
cholecystitis, etc.
Increased total bilirubin level due to associated
  • total bilirubin – 8.5-20.8 µmol / l
  • direct bilirubin – 0.85-5.1 µmol / l
Indicates reduced conjugation (binding) of bilirubin Hemolytic anemia, Minkowski-Chauffard’s disease, syndrome
Gilbert, Crigler-Nayar syndrome
Transaminase elevation (AST and ALT)
  • AST – 0.1-0.45 mmol / l
  • ALT – 0.1-0.68 mmol / l
Speaks about the inflammatory process and the destruction of the liver
cell
Hepatitis, cholelithiasis, chronic cholecystitis, cancer
gallbladder
Increased blood cholesterol 3.3-5.5 mmol / l Indicates increased fat metabolism. Atherosclerosis of vessels, obesity, cholelithiasis,
chronic cholecystitis
Reducing blood cholesterol 3.3-5.5 mmol / l Indicates a decrease in liver function Acute hepatitis, acute cholangitis, acute cholecystitis, cirrhosis
печени, рак печени и gallbladder
Increased alkaline phosphatase activity 0.5-1.3 mmol / h * l Indicates bile stasis in the liver and bladder Cholelithiasis, chronic cholecystitis
The appearance of C-reactive protein not detected Talking about acute inflammation Acute cholecystitis, cholelithiasis, acute cholangitis

Instrumental methods for diagnosing biliary disease
systems

Diagnostic method Cholelithiasis Chronic cholecystitis Biliary dyskinesia Acute cholangitis Gallbladder cancer
Abdominal ultrasound Concretions, gall sand, “porcelain” gall
bubble
Утолщение, деформация стенки gallbladder, признаки
inflammations
  • Hyperkinetic type: intense shadow of the bubble, its size
    reduced.
  • Hypokinetic type: increase and omission of the bubble
Signs of hypertension in the bile ducts, their
expansion
Increase bubble density
Fractional duodenal sounding Reducing the amount of gallbladder, changing biochemical
the composition of bile, the presence of bacteria
  • Hyperkinetic type: the evacuation of bile is accelerated, its amount
    reduced.
  • Hypokinetic type: bubble emptying slowed down
Reducing the amount of gallbladder, changing biochemical
the composition of bile, the presence of bacteria
Tumor cells are found in bile
Radiography Calcium-containing stones are detected Утолщение, деформация стенки gallbladder, признаки
inflammations
No changes Not used When using contrast, a filling defect is detected with
rough contours
CT scan Used as an additional research method for
making a diagnosis
Used to detect metastases and tumor germination in
neighboring organs
ECG Conducted to exclude acute myocardial posterior lower wall
myocardium
Fibrogastroduodeno-scopy Superficial gastritis

 Principles of treatment

Diet number 5 (for more information on what you can eat with cholecystitis and
stones in the gall bladder).

  • food taken 4-6 times a day in small portions
  • warm drink: weak tea, fruit and berry juices,
    diluted with water, dogrose broth for 3-6 glasses per day
  • porridge: semolina, oatmeal, rice
  • vegetable soups
  • lean fish and meat
  • dairy products: cottage cheese, sour cream, ryazhenka, cream
    butter
  • vegetable fats

Cholelithiasis

  • bed rest
  • diet number 5 – with the exception of fatty, high-calorie and rich
    cholesterol food
  • normalization of body weight
  • Ursodeoxycholic Acid preparations: Ursofalk, Ursosan,
    Ursolizin, holodexan (to improve the flow of bile)
  • antibacterial therapy – cephalosporins 3-4 generations
    (fortum, cefotaxime, cefazolin) or aminoglycosides (tobramycin,
    amikacin) or fluoroquinolones (ciprofloxacin, levofloxacin)
  • myotropic antispasmodics (mebeverdin, duspatalin) – for relieving
    muscle spasm with colic
  • hepatoprotectors – for the prevention of reactive hepatitis
    (Essentiale, Heptral, see the complete list of drugs for the liver)
  • narcotic and non-narcotic analgesics – nalbuphine, ketans,
    promedol

With frequent bouts of liver colic
surgical treatment – removal of the gallbladder
(cholecystectomy).

Chronic cholecystitis

  • diet number 5 – with the exception of fatty, high-calorie and rich
    cholesterol food
  • bed rest в течение 7-10 дней
  • broad-spectrum antibacterial drugs: 3-4
    generations (fortum, cefotaxime, cefazolin) or aminoglycosides
    (tobramycin, amikacin) or fluoroquinolones (ciprofloxacin,
    levofloxacin)
  • myotropic antispasmodics (mebeverdin, duspatalin) – for relieving
    muscle spasm with colic
  • enzyme preparations – Creon, Pancreatin, Festal, Panzinorm,
    Enzistal, Penzital, Hermital, Mezim, Gastenorm, Mikrozim, Pangrol and
    others
  • antisecretory drugs: almagel, maalox, omez, controls,
    rhinitis, quamel

Biliary dyskinesia

  • eliminating stressful situations, taking antidepressants and
    sedatives (see sedatives for
    adults)
  • diet number 5
  • drugs that eliminate the spasm of the muscles of the bladder – no-spa,
    papaverine, drotaverine, mebeverdin
  • Herbal preparations: arnica, virgin,
    душица, бессмертник, аир и другие
  • choleretic drugs – magnesium sulfate, sorbitol, cholagol,
    allohol, digestal
  • physiotherapy – inductothermy, diadynamic
    currents, UHF

Acute cholangitis

  • broad-spectrum antibiotics: semi-protected
    penicillins (amoxiclav), cephalosporins of 3-4 generations (ceftriaxone,
    cefepime), fluoroquinolones (moxifloxacin, gatifloxacin)
  • myotropic antispasmodics (mebeverdin, duspatalin) – for relieving
    muscle spasm with colic
  • ферменты – Фестал, Мезим, Креон и others см. выше.
  • antipyretic drugs – paracetamol, acelizin, infulgan
  • narcotic and non-narcotic analgesics – nalbuphine, ketans,
    promedol

Gallbladder cancer

Cancer treatment depends on the prevalence of the tumor process.
Usually, gallbladder removal, partial removal
liver and adjacent lymph nodes. Therapy must
to be combined, that is to combine as a surgical
treatment, and chemotherapy, radiation therapy.

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