I once went to a free clinic in the countryside, and an old gentleman said to me, "Doctor, I have had repeated stomach pains for many years, and eating greasy food will aggravate it." After the last two weeks of eating, the feeling of full stomach distention is obvious, and I still feel nauseous, and I have been taking drugs to treat stomach diseases and have not improved. What's going on here? ”
After the physical examination, I told him, "You probably don't have a stomach problem, but cholelithiasis." It is recommended to go to the hospital for an ultrasound. ”
Sure enough, the old man came back to me with the results of the examination, and the report showed that gallbladder stones and common bile duct stones needed surgery. Hearing this result, the old man said to himself several times: "Well, why did you grow a stone on the gall?" ”
How do gallstones grow?
Cholelithiasis, also known as cholelithiasis, gallstones, including stones that occur in the gallbladder and bile ducts, is a common disease of the digestive system, and the incidence in adults is as high as 8% to 10%. The incidence of obesity, multiple births, and women over 40 years old is significantly higher than that of men[1], so not only the boss, but also the middle-aged mother should pay more attention to their bodies.
A patient once asked: Is the gallstone caused by not eating breakfast normally?
I said that the process of gallstone formation is very complicated, dietary factors are one of the important factors that cause gallstones, in addition to 97% of the water in the bile, there are bile salts, cholesterol, bile pigments, etc., any cause caused by the movement of the gallbladder dysfunction will lead to excessive concentration of bile in the gallbladder, resulting in gallbladder stones [2].
You often do not eat breakfast, the bile stored all night can not be discharged in time, the concentration will naturally increase, the risk of forming gallbladder stones will increase.
In addition to irregular diet, there are also high cholesterol diet, high sugar diet, obesity, diabetes, high blood lipids, biliary tract infections, parasites, drugs, too little activity and cirrhosis, genetic and even regional factors, can cause bile secretion disorders, composition changes and other changes, to a certain extent will affect the dissolution of cholesterol, bile pigments and other components, resulting in crystal precipitation, accumulation, calcification, and gradually form stones.
It is precisely because the crystalline composition is different that the stones formed are also different.
This is how cholesterol stones, bile pigment stones, mixed stones, black stones, etc. are derived. It sounds "colorful", but it is actually not a good thing.
gallstone
Source: Stand Cool Helo
What are the manifestations of cholelithiasis?
The presentation of patients with cholelithiasis depends mainly on whether the stones are co-infected, whether there is biliary obstruction, and the location and extent of the obstruction.
For example, some gallbladder stones are "resting", which means lying there quietly, not doing or making trouble, and may not cause any symptoms for a lifetime.
Some stones are in the liver, and the usual symptoms are not obvious, but when the resistance declines, it is easy to appear inflammation such as right upper abdominal distension and fever. Many patients with cholelithiasis will have different degrees of epigastric pain, heartburn, belching, nausea, bitter mouth, fullness after meals, etc., which are very similar to chronic gastritis and other manifestations, and are easy to misdiagnose as "chronic stomach disease". That's why, the old gentleman at the beginning always thinks of a cholelithiasis attack as a "stomach pain.".
Gallbladder stones
In the case of overeating, eating greasy food, mental stress, overwork, low resistance, etc., it is easy to induce gallstones and inflammation, and the patient's right upper quadrant vague pain will be aggravated.
At this time, if the gallbladder stones are blocked and the bile cannot flow out, it will cause severe colic in the right upper quadrant; if the total pipeline of bile excretion is blocked, there will be pain in the right upper quadrant, chills, high fever (39 to 40 ° C), jaundice and other manifestations, then it is necessary to urgently send to the hospital.
Diagnosis of cholelithiasis is not difficult, and the vast majority of patients can be diagnosed by ultrasound. When gallstones are suspected and ultrasound is unclear, CT or magnetic resonance cholangiopancreatography may be selected. Intrahepatic bile duct dilation is present in individual patients, but CT or magnetic resonance pancreatography is not diagnostic, and percutaneous hepatic aspiration cholangiography may be considered.
Doctors will combine the patient's medical history, symptoms and examination results to make a comprehensive judgment, and once cholelithiasis is diagnosed, it should be actively treated.
How to treat cholelithiasis?
Cholelithiasis is usually seen in general surgery or hepatobiliary surgery. If there are no self-conscious symptoms, you can review it regularly once a year, but usually pay attention to a light diet, life rules, and moderate exercise to avoid aggravation of the disease.
If the symptoms of cholelithiasis are obvious or recurrent, it is necessary to treat it surgically as soon as possible to avoid serious complications such as cholangitis, obstructive jaundice, and biliary pancreatitis. In the acute onset of biliary colic, you can also go to the emergency department for initial treatment to control the disease, and then transfer to hepatobiliary surgery as soon as possible.
Acute cholecystitis
Some non-surgical therapies, such as extracorporeal shock wave lithotripsy, lysate stones, etc., have a long course of treatment, stones are not easy to discharge, the effect is not accurate, and it is difficult to relieve the symptoms caused by stones (especially biliary obstruction) as soon as possible.
For patients with recurrent symptoms, surgery is currently the only way to resolve biliary stones. The doctor's advice, you must remember it.
Minimally invasive surgery is currently the preferred treatment for gallstones, with small trauma, fast recovery, and almost no scars, these advantages are known to everyone, and I will not list them.
But here, I want to focus on the choice of surgical method:
Patients with symptomatic gallbladder stones may be treated with laparoscopic cholecystectomy;
Patients with bile duct stones can be treated with endoscopic retrograde pancreatic bile duct lithotripsy, sphincter incision stone retrieval or laparoscopic bile duct exploration combined with cholecystectomy, the efficacy is generally very good, there will be no obvious sequelae;
Individual patients with complex conditions may require relatively complex surgeries and other methods of treatment. The doctor will definitely consult with you when the time comes, so don't worry too much. Working well with the doctor during treatment is the best way to defeat the disease. Let the doctor bother you about the treatment.
bibliography
Chen Xiaoping,Wang Jianping,Zhao Jizong. Surgery (9th Edition)[M].Beijing:People's Medical Publishing House,2018:431-455.]
Liu Chao,Xue Dongbo. Research Progress on the Mechanism of Gallbladder Cholesterol Stone Occurrence[J]. Medical Review,2019,25(11):2103-2108.
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