Cloelithiasis

Cloelithiasis - the disease caused by formation of stones in a gallbladder or cholic ducts, and also possible disturbance of passableness of ducts owing to an occlusion a stone. In Europe and America 50 years the cloelithiasis aged is more senior suffer about 1/3 women and about 1/4 men. Obvious communication of prevalence with a floor appears. There are till now inexplicable differences of frequency a cloelithiasis: in Ireland the cloelithiasis on the average is available at 5 %, and in Sweden - for 38 % of inhabitants.

Aetiology

Stagnation of bile, growth of concentration of salts of bile. Stagnation of bile is promoted by pregnancy, a sedentary life, a hypomotor dyskinesia of cholic pathes, poor Adepses nutrition. The important factor is the inflammation, the inflammatory exsudate contains a considerable quantity of protein and calcium salt. Protein can become a kernel of a stone and calcium, being bridged by bilirubin, forms a definitive kind of a stone.

Pathogenesis

Distinguish 4 types of concrements:

• the cholesteric stones containing about 95 % of cholesterol and a few of a bilirubinic lime
• the pigmental concrements consisting in basic from the bilirubinic lime, cholesterol in them less than 30 %
• admixed, cholesterol - it is pigmental - calcareous stones
• the calcareous stones containing to 50 % of a carbonate of calcium and a few of other components

Cloelithiasis - a symptom a complex including not only formation of stones, how many presence of a typical cholic colic the pathogenesis of last is a progression of a stone, a spastic stricture and an obturation of cholic pathes. The stones located in the field of a bottom and a body of the gallbladder, usually clinically do not show, i.e. are "mute"-25-35 % of persons of both sexes the ambassador 65лет are such "carriers".

Clinical picture

Cholic colic - the syndrome characterised by subitaneously arisen acute pains in right hypochondrium, irradiating in the right clavicle, in the right arm, in a back, accompanied by a nausea, vomiting. In vomitive masses there can be a bile, from here sensation of sharp bitterness in a mouth. At long pains and at obstruction the itch of a skin educes and a little bit later there is a yellowness. Symptoms of a boring of a peritoneum are possible.

At an occlusion of a vesical duct probably formation of inflammatory process, a gallbladder edema. In the presence of an inflammation the cholangitis, a cholangiohepatitis can educe, at an incomplete obturation - a secondary biliary cirrhosis. At a stone delay in the general cholic duct the obstruction and a pancreatic duct with formation of an acute pancreatitis, including bound and with a bile reflux in a bile leakage is possible.

At inspection of the patient it is possible to find the enlarged gallbladder, but it can be and wrinkled, contained in it can practically not be. As a rule, at such patients the liver, it soft, painful is enlarged at a palpation.

Are characteristic a number of symptoms. An Ortner's symptom: morbidity at effleurage on edge of the right costal arch. Murphy's symptom: intensifying of pains at pressing on an abdominal wall in a projection of a gallbladder during a deep inspiration. The Ker symptom: the same at a palpation in a gallbladder point (in an angle formed by a costal arch and edge of a direct muscle of a gaste.). Zakharyin symptom: the same at effleurage in a point of crossing of the right direct muscle of a gaste with a costal arch. Mussies symptom: morbidity at pressing between legs right sternoclaviculare - a mastoid muscle (phrenicus - the symptom is caused by radiation of pains on the phrenic nerve participating in an innervation of a capsule of a liver and a gallbladder). Beckman's symptom: morbidity in right over orbital region. Yoshi's symptom: the same in an occipital point on the right. Mayo-Robson's symptom: morbidity at pressing in range costolumbar an angle.

Diagnostics

Cloelithiasis. Stones are taped radiological and ultrasonic by research methods. The cholecystography, an intravenous cholegraphy, radionuclide gallbladder scanning are used.

At suspicion on a tumour, at a mechanical icterus of the obscure genesis, a concomitant lesion of a liver - fibroduadenopancreatocholangiography, a laparoscopy and laparoscopic cholecystocholangiography. Laboratory tests: high level of bilirubin, augmentation of the maintenance of cholic acids, signs of inflammatory process in blood. At a full occlusion of the general cholic duct of an urobilin in urine is not present, probably sharp augmentation of abjection of cholic acids.

Treatment a cloelithiasis

The most part of patients are exposed to a surgical intervention. Conservative treatment is referred on dissolution of stones. For this purpose use the preparations containing chenodesoxycholic or ursodeoxycholic acid. Chenodesoxycholic acid (Chenofalk, Сhenodiol, Henohol, Ursofalk). An initial dose 750 - 1000 - 1500 ml (depending on body mass) a day. Course of treatment fluctuates from 4-6 months till 2 years.

The combined preparation - Litofalk, 1 tablet contains on 250 mg ursodeoxycholic and chenodesoxycholic acids, is prescribed on 2-3таблетки a day.

Other methods. Rovahol, consisting of 6 cyclic monoterpenes (a metol, mentel, pinek, boneol, camphene and cineol) in an olive oil. It is prescribed on 1 capsule to 10 kg of mass of a body a day. Duration of treatment same, as well as cholic acids, phytogenesis Medical products: preparations of an immortelle sandy, tansies ordinary, mints peppery, Cornsilk, etc. the bile Lithogenicity decreases at reception of phenobarbital or Zixorin (300 400 mg/days of 3-7 weeks.).

For preventive maintenance of formation of new stones restriction of power value of nutrition, consumption cholesterol of keeping products (Adeps, eggs), appointment of a cellulose, wheaten bran, vegetables is recommended.