Gallstones
Introduction
Introduction to gallstones Gallstones are diseases caused by stones that occur in the gallbladder and are a common disease. With age, the incidence rate is gradually increasing, and women are significantly more than men. With the improvement of living standards, changes in eating habits, and improvement of sanitary conditions, China's cholelithiasis has gradually changed from bile duct pigment stones to gallbladder cholesterol stones. After the stone is formed in the gallbladder, it can stimulate the gallbladder mucosa, which can not only cause chronic inflammation of the gallbladder, but also cause secondary infection when the stone is invaded in the neck of the gallbladder or the cystic duct, leading to acute inflammation of the gallbladder. basic knowledge The proportion of illness: 0.34% Susceptible people: no special people Mode of infection: non-infectious Complications: bile duct stones gallbladder cancer ulcerative colitis acute cholangitis acute suppurative cholangitis acute biliary pancreatitis Mirizzi syndrome
Cause
Gallstone cause
Hi quiet less (25%):
Many women, especially middle-aged women, often spend more time at home, less exercise and physical labor. Over time, the contractile force of their gallbladder muscles will inevitably decline, and bile emptying will delay, which will easily lead to cholestasis, cholesterol crystals, and gallstone formation. Created conditions, in addition to the high level of estrogen in the female body, will affect the formation of glucuronide in the liver, so that unconjugated bilirubin increased, and estrogen affects the gallbladder emptying, causing bile stagnation, promote The formation of stones, the use of estrogen after menopause, the incidence of gallstones increased significantly.
Physical obesity (10%):
Many women usually love high-fat, high-sugar, high-cholesterol drinks or snacks. The direct result of this hobby is the body's blessing, and obesity is an important basis for gallstones. Studies have shown that body weight exceeds 15% of normal standards. People, the incidence of gallstones is five times higher than normal people, and women over 40 years old are the highest-rising group of gallstones. At this time, female estrogen will cause cholesterol to accumulate more in the bile.
Do not eat breakfast (5%):
Modern women do not eat breakfast more than eat breakfast, and long-term not eating breakfast will increase the concentration of bile, is conducive to bacterial reproduction, easy to promote the formation of gallstones, if you insist on eating breakfast, can promote part of bile outflow, reduce The viscosity of bile stored overnight reduces the risk of gallstones.
Multiple pregnancies (5%):
During pregnancy, biliary tract function is prone to disorder, resulting in weak muscle contraction, retention of bile in the gallbladder, and relatively high blood cholesterol during pregnancy, which is prone to sedimentation. The chance of forming gallstones is greatly increased, while the incidence of prolific women is increased. higher.
After-dinner snacks (5%):
Nowadays, many families in our country can see such a situation. After eating a supper, the family is sitting leisurely on the sofa, chatting and watching TV while eating snacks. The habit of sitting and eating snacks after a meal may be the incidence of gallstones in China. One of the reasons for the heightening, when the person is in a distorted position, the intra-abdominal pressure increases, the gastrointestinal motility is limited, which is not conducive to the digestion and absorption of food and bile excretion. Sedentary after meals hinders the reabsorption of bile acids. The ratio of cholesterol to bile acid in the bile is imbalanced, and cholesterol is easily deposited.
Hepatic cirrhosis (5%):
This is related to the reduction of estrogen inactivation in the body of patients with cirrhosis. The estrogen inactivation function in the body is reduced, the estrogen level is higher, and the cirrhosis of the gallbladder is low, the gallbladder is not empty, and the biliary vein is not smooth. A variety of factors, such as varicose, elevated blood bilirubin, can cause gallstones.
Genetic factors (10%):
Genetic factors play an important role in clarifying the risk of gallstones. Gallstones are more common in close relatives of patients with cholesterol cholelithiasis. Local Americans in the southwestern United States are at high risk of cholesterol cholelithiasis (>80%). This seems to contain a genetic factor.
As a general rule of stone formation, they have the basic processes of precipitation, precipitation, nucleation and accumulation of bile components. The pathogenesis includes several factors. First, cholesterol or calcium in bile must be supersaturated. Second, the solute must be nucleated from the solution and precipitated as a solid crystal. Third, the crystals must be aggregated and fused to form stones. The crystals grow and aggregate in the mucus, which is distributed throughout the gallbladder wall, and the gallbladder emptying is impaired to facilitate the formation of gallstones.
Cholesterol stones ----The formation of cholesterol stones is based on the imbalance of cholesterol, bile acid and lecithin in bile, which causes the cholesterol in bile to be supersaturated and crystallize, precipitate, aggregate, stone, and large. The cholesterol in some bile is derived from the biosynthesis of hepatocytes, not the secretion of cholesterol in the diet. The formation of cholesterol stones is mainly due to the supersaturated cholesterol in the bile synthesized by hepatocytes, and the cholesterol-promoting crystals in the bile. Nuclear effects, other factors should be attributed to gallbladder motor function damage, they work together, resulting in bile stasis, promote gallstone formation, in addition, there are still some studies show that changes in gallbladder prostaglandin synthesis and bile calcium concentration Excessive high may also promote the formation of gallstones. In some patients, the prerequisite for gallstone formation is the formation of biliary mud. The so-called biliary mud is composed of viscous glycoprotein containing cholesterol crystals. Detected, and may be biliary colic, can be found in patients with pancreatitis or cholangitis The only exception.
Gallstones----including black stones and brown stones. Black stones are mainly formed in the gallbladder of patients with cirrhosis or chronic hemolytic disease, while brown stones can be found in the gallbladder or in the biliary tract. Formation, bacterial infection is the main cause of primary bile duct stones, primary bile duct stones are very common in Asia, the source of infection may be attributed to parasites such as Clonorchis sinensis or other less clear causes.
The incidence of gallstones increases with age and occurs in women. The prevalence of women of childbearing age and men of the same age exceeds 3:1, and after 70 years, it drops to 2:1, pregnancy, obesity, westernized diet, Total parenteral nutrition and other factors can increase the risk of gallstones. In addition, ethnic factors are also associated with the disease. For example, the prevalence of Indians in the western United States exceeds 75%, which is the highest incidence of gallstones in the world.
Prevention
Gallstone prevention
1. Diet regulation is the most ideal preventive method to prevent cholelithiasis and gallbladder cancer. Prevention of gallstones should pay attention to diet regulation, diet should be diverse, in addition, cold, greasy, high protein, irritating food and spirits and other easy to help heat and heat, so that cholestasis, should also eat less. Vegetables and fruits, fish and seafood that are rich in vitamin A and vitamin C help to clear the dampness, dissolve the stones, and eat more.
2. Life should be regular, pay attention to work and rest, often participate in sports activities, eat breakfast on time, avoid getting fat, reduce the number of pregnancies, etc. is also a very important preventive measure.
3. If the parents of the family have gallstones, they should pay attention to the relevant preventive medical examination.
Complication
Gallstone complications Complications bile duct gallstone gallbladder carcinoma ulcerative colitis acute cholangitis acute suppurative cholangitis acute biliary pancreatitis Mirizzi syndrome
Complications of gallstones include: acute cholangitis or acute suppurative cholangitis, biliary pancreatitis, Mirizzi syndrome, gallbladder gastrointestinal fistula.
Symptom
Gallstone symptoms Common symptoms Abdominal pain Resting stones Pigmented gallstones Dyspepsia Anorexia stones Liver fibrosis Hepatic dysfunction Liver function Abnormal bilirubin calcium stones
symptom:
1. Gallbladder stones usually have no obvious symptoms in the early stage, and most of them are found in routine physical examinations. Sometimes it can be accompanied by mild discomfort and is mistaken for stomach disease without timely visit.
2, part of single or multiple gallbladder stones, free to exist in the gallbladder, not easy to incarceration, rarely produce symptoms, known as asymptomatic gallstones.
3, small stones in the gallbladder can be invaded in the neck of the gallbladder, causing clinical symptoms, especially after eating a greasy diet, gallbladder contraction, or due to changes in body position during sleep, can make the symptoms worse.
4, when gallstones are embedded in the neck of the gallbladder, causing acute obstruction, resulting in increased pressure in the gallbladder, bile can not be discharged through the gallbladder neck and cystic duct, causing clinical symptoms, usually manifested as biliary colic. Sustained right upper quadrant pain, paroxysmal aggravation, can be radiated to the right shoulder, often accompanied by nausea and vomiting. Some patients can relieve their symptoms spontaneously after a few hours.
5, if the gallbladder stone incarceration continues to not relieve, the gallbladder will continue to increase, and even combined with infection, and thus progress to acute cholecystitis, if the treatment is not timely, a small number of patients can progress to acute suppurative cholecystitis, can occur in severe cases Perforation of the gallbladder, clinical consequences are serious.
Examine
Gallstone examination
1. Ultrasound examination.
2. Oral or intravenous cholecystography.
3. Computed tomography (CT).
4. Endoscopic retrograde cholangiopancreatography (ERCP).
5. Percutaneous transhepatic cholangiography (PTC).
6. Endoscopic ultrasound (EUS).
7. Nuclear magnetic resonance cholangiography MRCP.
8. Spiral CT bile duct imaging.
9. Radionuclide scanning.
Diagnosis
Diagnosis and diagnosis of gallstones
diagnosis
Gallstones with a history of acute attacks are generally difficult to make a diagnosis based on clinical manifestations. However, if there is no history of acute attacks, the diagnosis depends mainly on auxiliary examination. B-ultrasound can correctly diagnose gallstones, showing the light inside the gallbladder and the sound behind it. Shadow, the correct rate of diagnosis can reach 95%, oral gallbladder angiography can show the gallstone shadow in the gallbladder, in the gallbladder bile obtained in duodenal drainage (ie beta bile), found cholestasis or cholesterol crystals, help diagnosis.
Differential diagnosis
(1) Liver diseases: such as viral hepatitis, cirrhosis, etc.
(2) Gastrointestinal diseases: such as gastrointestinal dysfunction, peptic ulcer, high appendicitis and right colon disease.
(3) biliary tract diseases: such as biliary dysfunction, gallbladder tumors, gallbladder polypoid lesions and biliary parasites.
(4) Others: such as right pyelonephritis, herpes zoster and radiculitis.
