According to statistics, about 7% of Chinese people suffer from different types of gallstones, including intrahepatic bile duct stones, gallbladder stones and extrahepatic bile duct stones. Gallstones bring us not only pain, but also jaundice, infection and even cancer. In recent years, there is a high incidence of gallstone disease and a trend towards younger people. We will be very concerned: How do we know that we have gallstone disease? What should I do if I have gallstone disease? Can gallstone disease be prevented?
How do I know I have gallstone disease?
Gallbladder stones, extrahepatic bile duct stones and intrahepatic bile duct stones have their own characteristics.
Most gallbladder stones are asymptomatic at the beginning. In some cases, the presence of a hyperechoic cluster in the gallbladder is detected by ultrasound during a physical examination, and in about 1/3 cases, the diagnosis is made during an attack of biliary colic. If gallstones move in the body of the gallbladder to the neck of the gallbladder blocking the drainage of bile to the cystic duct, the sudden increase in pressure in the gallbladder causes severe pain in the right upper abdomen, which can be so painful that it can cause people to roll around. The pain can also occur in the heart fossa or left chest, radiating to the back of the lower back and right shoulder. If the stone leaves the obstruction, the pain may stop. If the obstruction persists for more than 6 hours, jaundice or even acute cholecystitis may occur. If the stone falls into the common bile duct, symptoms of choledocholithiasis may appear.
Extrahepatic bile duct stones are usually difficult to detect even on physical examination. Symptoms appear only when it migrates to the lower opening of the common bile duct and becomes lodged, causing obstruction of bile drainage. The symptoms are slow onset right upper middle abdominal pain, abdominal distension, and nausea, which gradually develop into severe pain of longer duration. Jaundice and secondary biliary tract infection may occur if the obstruction is not lifted for a long time, which may be life-threatening in severe cases. The diagnosis can be confirmed with the help of retrograde cholangiopancreatography under gastroscopy or magnetic resonance cholangiopancreatography.
Most intrahepatic bile duct stones have mild symptoms. There is vague pain in the right upper abdomen or liver area, mostly associated with infection. There may be hypothermia and jaundice. Ultrasound, CT, MRI can diagnose.
What should I do if I have gallstone disease?
Different sites, different stages of gallstone disease and different components of gallstones determine different treatments. Let’s explore the following questions.
1. Can gallstones be dissolved?
So far, the effect of drug lithotripsy is very poor. In particular, most of the gallstones in Chinese people used to be bile pigment component, but nowadays, although the proportion of cholesterol stones has increased, there are many mixed stones of both bile pigment and cholesterol. Unfortunately, the available lithotripsy drugs are only effective for cholesterol stones. There are two types of oral lithotriptic drugs in common use: goose deoxycholic acid and ursodeoxycholic acid. They are the main bile salts that dissolve cholesterol in the bile. They act mainly to inhibit cholesterol synthesis, reduce cholesterol secretion or decrease cholesterol reabsorption in the small intestine, and also promote the ability to bind cholesterol to phospholipids. Ursodeoxycholic acid is more effective than goose deoxycholic acid in lithotripsy, has fewer side effects, and does not damage the liver when taken for a long time, with an efficiency of 20-40%. The difficulty of lithotripsy is that it is not possible to accurately determine whether the cholesterol is the main component of the stone, and the time required for lithotripsy is long and the cost/effect ratio is not ideal. Therefore, it is suitable for patients with quiescent gallstone disease and patients who are not suitable for surgical treatment.
2.How about lithotripsy treatment?
The success rate of ultrasonic lithotripsy is very high, reaching 85-95%, but the stone removal rate is not high, only 7-50%, and the recurrence rate is 6% in 1 year and 21% in 2 years. Direct lithotripsy and stone extraction with choledochoscopy or duodenoscopy is also more effective in the near future. Therefore, lithotripsy is usually not the first choice.
3.What are the long-term risks of surgical removal of gallbladder?
Surgery for gallstone disease is also a last resort. After all, the gallbladder is an important organ for regulating bile excretion and storage. Removal of the gallbladder is only an option after weighing the pros and cons in the face of the threat of stones. In comparison, cholecystectomy for gallstones is certainly effective and rapid. Especially since the invention of laparoscopic cholecystectomy, many patients with simple gallbladder stones have benefited from it with less trauma and faster recovery. However, laparoscopic surgery is not suitable for patients with severe cholecystitis or for patients who require simultaneous exploration of the common bile duct. Since gallstone formation is related to the imbalance of various components in the bile, gallbladder removal does not guarantee that gallstones will not recur, and in some patients new stones may develop in the bile ducts after surgery. After gallbladder removal, bile loses its storage depot, and if a large amount of bile is secreted in a short period of time, bilious diarrhea can occur in the intestine. In contrast, if a large amount of fat is eaten, poor fat absorption diarrhea can occur due to insufficient bile secretion. Pain in the biliary area is a common postoperative surgical problem, which may be caused by residual cholecystitis or stump neuroma, and sometimes even requires another caesarean section.
4.Do intrahepatic bile duct stones need treatment?
Due to the popularity of ultrasound, the detection rate of bile duct stones in China has increased significantly. Most of the patients do not have symptoms, but they are worried and can’t wait for the end of the day. In fact, a small number of intrahepatic bile duct stones do not require surgery, but mainly bile ducts and prevention of infection. Only a large number of stones combined with bile duct infection, which seriously affects the function of the liver and bile ducts, will require lobectomy. Therefore, regular follow-up is usually sufficient for intrahepatic bile duct stones.
Can gallstone disease be prevented?
This is a long story. First of all, it is interesting to look at a large scale survey done by the National Gallstone Collaborative Group in 1987 and another nationwide survey in 1995, which analyzed the changes in gallstone disease in China during the decade from 1983 to 1992. The results of the survey showed that the prevalence of gallstones in women was 2-2.5 times higher than that in men, with a peak incidence of 40-60 years old, and these changes were not significant over the decade. However, the effect of dietary structure change on gallstone composition was obvious: among gallstone patients, the proportion of protein and fat in the diet increased one time more while the proportion of many kinds of vegetarian dishes decreased one time less, indicating that the increase of protein and fat intake and the decrease of vegetarian dishes intake contributed to the development of gallstones. The survey also showed that the number of gallstone patients with combined biliary ascariasis was 7 times higher 10 years ago than 10 years later, indicating that changes in hygiene conditions and hygiene habits have reduced the incidence of gallstones. Moreover, the ratio of gallbladder stones/bile duct stones was similar among workers, employees and farmers ten years ago, but after ten years, the ratio of gallbladder stones increased seven times among farmers, five times among workers and four times among employees, indicating that the improvement of living standard was favorable to the formation of gallbladder stones. However, gallbladder stones were only 2.8 times more common among farmers, 10 times more common among workers, and 13.4 times more common among employees, suggesting that different living standards have an effect on the type of gallstones.
This data shows that the improvement of living standard and the increase of protein and fat in the diet will increase the incidence of gallbladder stones; the improvement of hygiene conditions and habits will reduce the incidence of bile duct stones. Is this an important insight into the potential of gallstone prevention?
To illustrate the preventability of gallstone disease, it is useful to briefly review the results of studies on the causes of gallstones. Although too many factors are still unclear, the basic mechanism can be summarized as an imbalance in the ratio of cholesterol, bile pigments, bile acids and phospholipids in the bile, and a decrease in the solubility of cholesterol and bile pigments in the bile due to the action of many other contributing nuclear factors (e.g. mucin, calcium ions, -glucuronidase, etc.).
From this we can see that there are many controllable factors for gallstones, including at least.
1, reducing the concentration of cholesterol and bile pigments in the bile.
2, increasing the phospholipid and bile acid content of the bile.
3, correction of gallbladder dysmotility.
4, inhibition of the amount and activity of nucleation factors in bile
5.Increase the number and activity of anti-nucleation factors in bile.
Now we are going to introduce the things that can be done at the moment.
First, reawakening the importance of gallstone disease prevention to protect life safety. With the current level of treatment for gallstone disease, gallstone disease often invites devastating surgery. If you work in a highly mobile job, there is no guarantee that you will always be under the protection of excellent medical conditions, and gallstone attacks often take the form of surprise attacks, you may be subjected to life-threatening hardships, so it is best to avoid this disease. Gallstone disease is more commonly seen in women. The “3 F’s”, or feamal/fourty/fat (female, 40 years old, obese) are the ones who tend to suffer from gallstone disease. Gender, age involuntary, obesity sometimes born, these people should be more regular medical checkups, timely detection as the first.
Second, establish a healthy lifestyle. It is worth reminding that
1, to eat on time and evenly, so that the bile is evenly excreted. Often do not eat breakfast, the gallbladder storage of bile is not discharged at the right time and over-concentrated, easy to cholesterol precipitation into stones.
2, less curled up on the sofa to eat snacks. Computer and TV addicts often have this habit. Sitting is not conducive to bile secretion, snacking will unknowingly take in a lot of calories, plus more static and less mobile easy to cause obesity, are in the formation of gallstones on the code.
3, less car more walking. Not only increase body vitality, but also facilitate the consumption of calories, to avoid fat accumulation, reduce blood lipids, especially cholesterol levels.
4, a balanced diet of protein, fat, a variety of vegetarian dishes ratio. This is especially important for the office family. Animal food is necessary for the human body, because it contains more high-quality protein, especially containing essential amino acids that the body can not synthesize itself. However, animal skin, offal cholesterol content is very high, too much consumption will make the blood cholesterol, conducive to the formation of gallstones. Too much vegetarianism is not enough protein, which also makes the content of Apo A-1 and A-2, the anti-stone formation protein, too low, so it is not desirable. Foods with high cholesterol content include animal offal (brain, kidney, liver, intestine), egg yolk, fish roe, squid, squid fish, crab, cream, butter, lard, etc. Foods with low cholesterol content include various vegetarian dishes, l meat, salmon, carrots, soybeans and soy products, fruits, oatmeal, raw garlic, vegetable oils, mushrooms, fungus, sesame seeds, etc. The daily diet can be appropriately matched, but should not be biased. The World Health Organization recommends that the daily cholesterol intake of normal adults should not exceed 200 mg.
5, to develop the habit of daily bowel movements. Feces can take away a large number of harmful bacteria such as E. coli in the intestine. The large amount of endotoxin produced by E. coli contains an enzyme called β-glucuronidase, which can lead to the combination of bilirubin and calcium ions in the bile to form bilirubin calcium precipitation and bile pigment stones formation.
6, do not eat poorly processed lettuce salad. Improperly treated lettuce is prone to contamination by parasite eggs. Biliary roundworm is an important factor in the formation of bile pigment stones.
7, eat more food rich in lecithin. Phospholipids within the bile are good for cholesterol dissolution. There is a lot of lecithin in the egg yolk. In the past, stressed that the yolk contains a lot of cholesterol, many people eat eggs when the yolk abandoned, as if to meet the plague, it is not necessary. The phospholipid content of soybeans is very high and does not contain cholesterol.
8, do not forget to wash your hands before and after meals. Especially important for remote rural areas, can reduce the incidence of ascariasis. China’s intrahepatic bile duct stones in recent years to reduce the incidence of roundworm disease is significantly related to the reduction.
Third, to actively treat and gallstone disease closely related to obesity, diabetes, chronic hepatitis, liver cirrhosis and other diseases. Cirrhosis has increased estrogen, intestinal tract due to portal hypertensive stasis leading to intestinal flora multiplication and dysbiosis ratio, increased amount of E. coli, bile secretion stagnation in liver disease is also common, liver cell damage increases blood bilirubin concentration, all of which are conducive to bile pigment stone formation. Obesity and diabetes mellitus are often accompanied by hypercholesterolemia, which favors cholesterol gallstone formation. Therefore, it is crucial to improve the condition to prevent gallstone disease.
Fourth, in addition to the above measures, patients who are already suffering from stone disease should also take some drugs that promote bile secretion and litholysis will help to control the development of the disease and avoid life-threatening consequences. For those who are found to have thick bile (poor bile transmission) or crystal formation in the gallbladder by ultrasound, early application of cholestatic and litholytic drugs can often prevent the formation of gallstones.