I. Clinical onset of cholecystitis and gallstones?
Cholecystitis and gallstones are among the most common surgical diseases. 80%-95% of patients with acute cholecystitis have stones in their gallbladder. Although medicine has made great progress in recent years and studies have identified numerous factors associated with it, the exact etiology is still unclear, which makes it impossible to completely prevent the occurrence of gallstones at this time, so cholecystitis and gallstones will remain one of the most common clinical diseases in the future.
Surgery is always something that people are reluctant to encounter, so emergency surgeons always see a group of “old faces” with repeated gallstone attacks repeatedly seen in the middle of the night. Some of these people end up having to undergo riskier emergency surgery, some have to eat more pain and spend more on medical expenses (often calculated in tens of thousands of dollars) due to pancreatitis, and even have life-threatening conditions, often receiving a “patient critical care notice” from the hospital.
Why do I need surgery for cholecystitis and gallstones?
In fact, anatomically speaking, the gallbladder and appendix are the same, both are provided with blood supply by a terminal blood vessel.
Why do greasy foods trigger gallbladder infection and gallstones attacks?
The human liver secretes about 800 ml of bile every day, a small part of which flows into the duodenum via the bile duct, and the vast majority enters the gallbladder via the bile duct, where it is stored and concentrated (about 10 times more concentrated). When the food reaches the duodenum, it stimulates the intestinal mucosa cells to produce a kind of cholecystokinin, which causes the gallbladder to contract strongly after 3-5 minutes, and at the same time makes the sphincter of Oddi open at the lower end of the bile duct in the duodenum, and the bile enters the intestine smoothly to help digestion. The stimulation of the duodenal mucosa is different due to the composition of the food. Fat, which depends mainly on bile to help digestion, has the strongest stimulating effect, protein has a weaker stimulating effect, while carbohydrates have almost no stimulating effect. Therefore, the gallbladder contraction is also the strongest after eating more fatty food. If there is inflammation or stones in the biliary system, it will cause pain due to the strong contraction of the gallbladder. Especially when there are stones in the gallbladder or bile duct, it can prompt the stones to get stuck in the opening of the gallbladder or bile duct, causing obstruction and severe unbearable colic, which is the acute attack of biliary tract lesions.
Fourth, the dietary choices and precautions for patients with cholecystitis and gallstones?
(1) Choose fish, lean meat, dairy, soy products and other foods containing high quality protein and relatively less cholesterol, and control the intake of animal liver, kidney, brain or fish in food.
(2) Ensure the supply of fresh vegetables and fruits. Green leafy vegetables, which provide the necessary vitamins and the right amount of fiber, should be ensured even more. Foods such as yogurt, mountain plant and brown rice are also beneficial to patients.
(3) Reduce the intake of animal fats, such as fatty meat and animal fats, and increase the proportion of vegetable oil intake such as corn oil, sunflower oil, peanut oil and soybean oil in moderation.
(4) Avoid eating chili, curry, mustard and other strongly stimulating foods, alcohol and coffee, strong tea.
V. What are the methods of treatment for gallbladder infection and gallstones?
In addition to surgical treatment there are non-surgical treatment, but only for some special patients, and the treatment time is long, the effect is not obvious, and easy to recur after stopping the drug. These methods are.
1.Oral lithotripsy
Among the many Chinese and Western drugs, ursodeoxycholic acid tablets are considered to be the most reliable. It requires more than six months of continuous medication, but less than 30% of the stones are completely dissolved.
2.Lithotripsy by perfusion
Methyl tert-butyl ether, or its compound solution, is directly perfused into the gallbladder through puncture for litholysis. This drug has some toxicity and is still in the research stage.
3.Lithotripsy
It includes herbal medicine, acupuncture, meridian point instrument and the combination of various measures of “total attack lithotripsy”. It is reported that the effect of stone removal can reach about 70%, but the elimination rate is very low, and the residual stones can still cause symptoms. The normal caliber of the gallbladder duct is 2 mm, and it is difficult to discharge stones with diameter exceeding this number.
4.Stone extraction
Directly puncture the abdominal wall or small incision into the gallbladder and introduce cholecystoscope to remove the stones. For large stones, ultrasonic lithotripsy head can be introduced to break them up first, and then remove them in pieces.
5.Lithotripsy
Lithotripsy can be combined with lithotripsy and lithotripsy. The success rate of lithotripsy is more than 80% for those with appropriate indications, but the rate of lithotripsy is less than half. The treatment without gallbladder preservation is cholecystectomy. It removes the gallstones along with the site of stone regeneration and can avoid recurrence. The disadvantage is that surgery is required and there is a possibility of surgical complications and accidents.
These methods are currently applicable to only a fraction of patients and cannot be promoted. The specific use must strictly follow the corresponding indications. If the gallbladder is already diseased, the stones are likely to recur after lithotripsy. Lithotripsy is not suitable for all patients as the number and size of stones are clearly defined. In addition, asymptomatic gallstones often do not require clinical treatment.
What kind of stones are the most dangerous?
Firstly, there are small stones, sometimes called silt-like stones, usually around 5 mm in diameter, which are easily drained by the gallbladder into the common bile duct and often get stuck at the exit of the common bile duct, leading to the most critical clinical conditions, acute obstructive purulent cholangitis and severe necrotizing pancreatitis, which are life threatening.
Secondly, there are some stones with a diameter of about 1.0 cm, which tend to jam the outlet of the gallbladder. In these patients, due to the stones jamming the cervical canal (gallbladder outlet) and long-term inflammatory adhesions, the stones will eventually jam the outlet, which will lead to purulent cholecystitis and even gallbladder necrosis and perforation.
Thirdly, there are huge stones, which are generally considered to be larger than 3.0 cm in diameter, and they are considered to have a high probability of causing “malignant transformation”.
Do you know the types of gallbladder surgery?
Cholecystectomy is the standard treatment for gallbladder stones, and laparoscopic cholecystectomy (LC) has become the gold standard for gallbladder removal. There is also a gallbladder incision to remove stones and preserve the gallbladder to treat gallbladder stones, which is easily accepted by patients who are afraid of organ removal, but is abandoned due to recurrence of gallbladder stones in more than 80% of patients; now the most advanced is the one-hole method of scarless laparoscopic cholecystectomy, which leaves no scars on the abdomen and results in faster and more beautiful recovery.
Do you know when is the most suitable time for surgery?
It is difficult to grasp the timing of surgery because it is not suitable for surgery when gallstones are attacked, and it is also easy to cause difficulties in patient’s decision.
When the gallbladder stone is in acute attack, due to inflammation, local tissue congestion, edema and adhesions, surgery may easily cause damage to the left and right hepatic ducts, common bile duct, portal vein and other important anatomical structures in the area, resulting in serious or even irreversible complications, causing lifelong pain to the patient. Therefore, emergency surgery is only considered for cholecystitis that has failed to respond to conservative treatment, has a short course (often limited to 3 days of onset), may cause gallbladder perforation, and is combined with acute obstructive suppurative cholangitis.
”Anti-inflammation first, then surgery” becomes the most common phrase that surgeons say to gallstone patients. The preoperative preparation takes more than two months, and in some cases 3-6 months. Only in this way can the complications of surgery due to inflammation and adhesions be reduced, the hospital stay be shortened, the pain be reduced, and the health be restored as soon as possible.
For gallstones patients with combined diabetes, heart disease, emphysema, kidney disease, liver disease and other important organ diseases, they must first have the appropriate adjuvant treatment to be suitable for gallbladder removal surgery.
Gallstones is one of the common surgical diseases, there exists a vast morbidity group and gallbladder surgery has been shaped, the key is to clarify what kind of patients must be operated? What type of surgery should be performed? When is the most appropriate time to undergo surgery? The key is to know what kind of patients must be operated and when is the most appropriate time to undergo the surgery? It is still necessary for a specialist with rich clinical experience to give you the right advice to protect your health.