Breakfast is the patron saint of the gallbladder (cause of disease)
Being in an outpatient clinic is like watching a movie, with different plots and interpretations of different lives.
The disease and the person’s character are mixed together to perform different exciting and helpless.
I still remember when I was admitted to medical school, at the entrance of our village, my second aunt took me by the hand and urged me to study hard, it is not easy to be a doctor. Help your aunt to think of ways to learn the treatment of gallstones, what drugs can be taken to get rid of the stones.
I solemnly nodded my head, and from then on, I took heart, expecting to have a panacea and treatment means that can cure the disease, I firmly believe that studying well can realize this wish, so the first year of school, the anatomy of gastroenterology properly studied in depth.
It was then that I really understood what bile and gallbladder were all about.
In simple terms, the gallbladder was named because at that time it was found that bile was in the gallbladder, but in fact, the gallbladder does not produce bile, it is just a temporary place where bile lives. Bile is secreted by the liver, temporarily aggregated in the gallbladder and, when needed, sinks through the bile ducts into the duodenum to participate in the breakdown and absorption of fats and other nutrients during digestion.
First of all, understand this, you will know why not to eat breakfast is very bad for the body, and even easy to get gallbladder disease gallstones hepatitis reasons.
At night bile begins to secrete and store to the gallbladder, in the morning, we eat some oily food, such as eggs, bile is called, immediately began to enter the duodenum from the gallbladder, play its role, decomposition of oily substances, into essential nutrients, this process, but also the process of bile consumption.
If you do not eat breakfast, bile has no use, continue to sleep in the gallbladder, will be stagnant, the formation of bile stagnation.
If you do not eat breakfast every morning, bile is smothered in the gallbladder every day, inertia increases and does not flow, and over time it will become a foreign body, causing inflammation and forming cholecystitis. Due to poor mobility, gallstones may also be formed. The bile secreted by the liver is also not excreted and stays in the liver, which can also form cholestatic hepatitis and cirrhosis of the liver.
Therefore, eating in the morning is a very, very important thing, the role is greater than lunch, and no regular breakfast is the primary cause of biliary stasis, cholecystitis gallstones.
My impression is that every year during the holidays back home, in the grandma and grandpa’s house, mom and second aunt often cook for everyone together, in the morning, second aunt always eat very little, or even not.
Now it seems that the formation of the disease is not an overnight cause, is a poor lifestyle habits lead to. Second Aunt’s gallbladder disease was formed for this reason.
But is it certain that you will get cholestasis if you don’t eat breakfast?
The conclusion is also negative. If you do not eat breakfast, especially if you often do not eat breakfast, you are much more likely to get gallbladder disease than others, and if there are other factors, then you are more likely to get gallbladder disease. This etiology is considered in Chinese medicine to be the weakness of the spleen and stomach caused by a poor diet, which creates a latent state of bile stasis.
Second aunt is very good to us and cooks very well, but also has a very heavy taste, at the same time, more fatty and fatty things, often fatty and sweet and thick taste, is also one of the causes of gallbladder disease. And Chinese medicine believes that fat, sweet and thick taste to produce moisture, moisture and heat mutual knot, fumigation bile will be yellow all over the body, the reason for this is because of the uncontrolled intake of fatty substances, causing the abnormal bile secretion appeared this reason. If you don’t eat breakfast, it’s not good to secrete bile, but if you take in too much oily substances, it will also cause abnormal bile secretion, so too much is not enough, and it’s important to have a balanced diet. It is not good to eat more fatty things, it is not good to eat less, and it is not good to eat at the wrong time.
I heard from my old family members that my second aunt also had a difficult life experience, and although she doesn’t say so herself, she often sighs and is depressed in a state that no one knows about. This is also one of the causes of cholecystitis. When depressed, the secretion of pentraxin and dopamine is disturbed, and this important neurotransmitter, which has an important impact on the digestive system, especially the bile secretion of the liver and the storage function of the gallbladder, is depressed for a long time, leading to negative feedback of the neurotransmitter, which indirectly affects the secretion and discharge of bile from.
Chinese medicine considers this state to be liver depression and qi stagnation, which is the first cause of jaundice in Chinese medicine. Liver depression and qi stagnation, dampness and heat, and reduced digestive capacity of the spleen and stomach lead to unfavorable bile drainage, bile stasis, cholecystitis and gallstones.
The three causes form these three diseases. Based on my understanding of my second aunt’s life experience, I later gradually understood and was so emotional that I wrote this paragraph of Weibo, which resonated with many old patients with cholecystitis as well as patients with other diseases.
”Disease is your life. The effect of going anywhere for treatment is not good, is there no cure for my disease? The patient’s anxiety is etched in his eyebrows. It must be said that many diseases are destined, on the one hand, genes, that is, the Chinese medicine physique, from the gift of parents; on the other hand, habits and mentality, whether they can go with the flow. The doctor’s responsibility: 1) to tell you to face reality objectively; 2) to teach you to cope with the future; 3) to help you live with the disease.”
The second aunt has been looking at cholecystitis for a long time, hoping for a medicine to completely cure gallstones cholecystitis and cholestasis. This desire every patient’s hope and also before I studied medicine, did not expect to be disappointed after studying medicine. In fact, it is possible that many diseases are determined by one’s own genes, as well as one’s own mentality and habits, and it is difficult to be able to change these, but this is the duty of a doctor.
The three acquired causes above, which have not been changed for a long time is the destiny of Aunt Yee to appear sick, and she is looking for a panacea. In fact, this panacea is in herself, and only when she changes herself can she recover completely.
The doctor’s duty lies in analyzing the current state, cholecystitis, cholestasis and gallstones. How to cope with them and learn to live with the disease. In fact, these three diseases are an optimal state as long as they are managed rationally and do not attack, or have fewer attacks.
The relationship between gallbladder stasis cholecystitis and gallstones
After understanding all this, I called my second aunt, who was overjoyed to hear that I had found the panacea, and that I did not hurt you for nothing, and that my second aunt’s gallstones were saved.
However, to the second aunt analyzed the above willing, her expression is a little disappointed, however, still recognized these truths, there is no such thing as an easy way, indeed, this is your second aunt’s life. The treatment of the disease for so many years has also made Aunt Yee gradually recognize my objectification advice.
Don’t worry, second aunt, as long as you can do the three things I told you.
I have not only gallstones here, but also cholecystitis and cholestasis, which are three diseases, are they not three diseases that are more serious than just one gallstone?
Second Aunt got the whole list of gallbladder diseases.
These are three different disease names, but they are closely related.
Cholestasis, or siltation for short, is a clinical condition common to a group of diseases caused by impaired bile production or/and impaired bile flow, also known as cholestasis syndrome.
Bile travels all the way from the hepatocyte to the duodenum, and a blockage at any one place creates a bile flow disorder that can occur anywhere in the entire pathway from the hepatocyte, the bile duct to the Vater’s jugular. It is important to distinguish primarily between intrahepatic and extrahepatic causes in clinical practice.
The most common intrahepatic causes are viral or other hepatitis, drug-induced and alcoholic liver disease. Less common causes include primary biliary cirrhosis, cholestasis during pregnancy, metastatic liver cancer, and a number of other less common conditions.
Extrahepatic causes of cholestasis are commonly associated with common bile duct stones or pancreatic duct cancer. Other less common causes include benign strictures of the common bile duct (often associated with previous surgical procedures), bile duct cancer, pancreatitis or pancreatic pseudocysts, and sclerosing cholangitis.
More subtle causes include changes in the basolateral membrane of the hepatic sinusoids and capillary bile duct membrane; cytoskeletal changes; abnormal regulation of bile secretion; increased paracellular permeability; and obstruction of the capillary and intrahepatic bile ducts.
Cholecystitis is a relatively common disease, often occurring together with gallstones or independently, with a high incidence. According to its clinical manifestations and clinical course, it can be subdivided into two types: acute and chronic, often combined with gallstone disease. It is the inflammation of the gallbladder, depending on whether there is an obstruction and the nature of the pain is different. Chronic cholecystitis can be transformed from acute cholecystitis, or may be the cause from is acute cholecystitis.
The pain is severe, often with obstruction such as gallstones, and is also considered by traditional Chinese medicine as painful if it does not pass, while without obstruction, the pain is often not severe.
Severe pain or colic in the right upper abdomen is mostly acute cholecystitis caused by stones or parasites embedded in the obstructed gallbladder neck, and the pain is often sudden and very severe, or presents colic-like. In non-obstructive acute cholecystitis of the gallbladder duct, the pain in the right upper abdomen is usually not severe, but mostly persistent and distending.
Gallbladder stones are mainly found in adults, more women than men, and the incidence increases with age after the age of 40. The stones are cholesterol stones or a mixture of cholesterol-based stones and black bile pigment stones.
Therefore, the basic etiology of the three is the same and can also be the cause of each other, and the relationship in the human body can be represented by drawing a diagram. The three diseases are three circles, and each person can have one of them alone, or any two of them, or all three in one.
Diagnosis of disease.
Aunt Er was diagnosed with gallstones as a nail in the coffin, this is easy, the ultrasound will see it clearly, the diagnosis will be clear and you will know where it is and the general nature of it.
Most patients are asymptomatic and are found only during physical examination, surgery and autopsy and are called stationary gallbladder stones. In a minority of patients, the typical symptom of gallbladder stones is biliary colic, manifesting as acute or chronic cholecystitis. Main clinical manifestations: this is the symptomatic diagnosis. In fact, the clinical symptoms of cholecystitis and gallstones can be exactly the same, the difference lies in the presence or absence of stones in the gallbladder.
1. Typical biliary colic
Childhood
This is due to contraction of the gallbladder or displacement of the stone plus vagal excitement, stone embedded in the gallbladder jugular
The pain is caused by the contraction of the gallbladder or the displacement of the stone and the excitation of the vagus nerve. The pain is located in the right upper abdomen or epigastrium and is paroxysmal, or the pain may increase in paroxysms and may be released to the right scapula and back.
The pain is paroxysmal, or the pain may increase paroxysmally, and may be released to the right scapula and back.
2. Epigastric vague pain
Usually, Aunt Er only felt vague pain in the upper abdomen or right upper abdomen when she ate too much food, ate high-fat food, was stressed at work or had poor rest, or had discomfort with fullness, belching, or erratic pain, which was once thought to be “stomach disease”.
Based on the typical clinical history of colic, the diagnosis can be confirmed by imaging. Ultrasound is preferred and is very definitive.
In the case of cholestasis, it is more common to start with the symptoms and see jaundice and itching of the skin. This is referred to as the three yellows: yellow face, yellow eyes, and yellow urine.
Itching of the skin may occur before the onset of jaundice and may disappear by the late stages of biliary liver disease. Long-term severe biliousness can be seen as skin xanthomas. Secondary manifestations of biliary siltation include steatorrhea due to impaired fat absorption, bone disease due to malabsorption of fat-soluble vitamins D, K and A, night blindness and bleeding tendencies.
Aunt Ernie has pruritus and jaundice is not obvious.
Cholestasis may have jaundice, but jaundice is not necessarily cholestatic, but may also be hepatocellular jaundice and hemolytic jaundice.
Therefore, the main diagnosis depends on the laboratory and ancillary tests. The main combination is elevated bilirubin; elevated serum alkaline phosphatase is the most characteristic liver function abnormality of cholestasis and is usually present first; both of these are present in liver function tests. These two elevations are diagnostic.
Ultrasound and other imaging tests are used to find out if there is a specific cause of biliary obstruction.
In the case of cholecystitis, the diagnosis is based on one more thing: the manifestation of inflammation. There are two main types of cholecystitis.
From the point of view of symptoms, exactly the same as gallstones, generally speaking
1. acute cholecystitis is typical biliary colic, 2. chronic cholecystitis is vague pain in the upper abdomen.
Second aunt is usually a chronic cholecystitis state.
① persistent dull pain or discomfort in the right upper abdomen, or accompanied by pain in the right scapular region. ②Digestive symptoms such as nausea, belching, acid reflux, abdominal distension and heartburn, aggravated by eating fatty food. ③The course of the disease is long, and the course of the disease is characterized by alternating acute attacks and remission. ④There may be percussion pain with mild pressure in the gallbladder area. ⑤ Mucus in the bile is increased, white blood cells are piled up, and the bacterial culture is positive. ⑥B ultrasound shows gallbladder stones, thickening of gallbladder wall, shrinking or deformation of gallbladder. (7) Gallstones, shrinkage or deformation of gallbladder, poorly contracted gallbladder, or faint gallbladder visualization are seen on cholecystography.
And
After a period of time, acute cholecystitis can appear ① Mostly triggered by the consumption of greasy food or appearing in anxiety and anger. ②Sudden onset of continuous severe pain in the right upper abdomen with paroxysmal aggravation, which may radiate to the right scapula, often with nausea, vomiting
vomiting, fever. ③ pressure pain and muscle tension in the right upper abdomen, Murphy’s sign is positive (this is a clinical doctor’s examination method, which I also did for my second aunt last time, lying flat on the consultation bed, the left hand is placed under the right ribs and the intersection of the external edge of the rectus abdominis muscle
If there is pain, the test is positive, suggesting cholecystitis). ④White blood cell and neutrophil counts are elevated, and serum jaundice index and bilirubin may be elevated. ⑤ B
Ultrasound shows enlarged gallbladder, thickened or gross gallbladder wall, floating light spots in the gallbladder, and stone images in the presence of stones. ⑥X-ray examination: abdominal plain film of gallbladder area may have enlarged shadow of gallbladder.
Pay attention to the differentiation –
The location of cholecystitis pain is special, and the pain of many diseases may be related to this area. Don’t think that just because you usually have cholecystitis, this attack must also be cholecystitis. Diseases are so capricious and many times do not follow the usual rules. For example, the characteristic right upper abdominal pain, while the pain in this area may also be acute pancreatitis, right lower pneumonia, acute diaphragmatic pleurisy, early herpes zoster in the chest and abdomen, acute myocardial infarction and acute appendicitis.
As for chronic cholecystitis, diseases similar to it are peptic ulcer, chronic gastritis, gastric dyspepsia, chronic viral hepatitis, gastrointestinal neurological disorder and chronic urinary tract infection.
Second Aunt had frequent stomach pains at that time and had suspected myocardial infarction, gastritis, etc. It was only later, after gradual cardiac examinations, as well as gastroscopy, etc., that other diseases were ruled out and localized to the gallbladder.
However, every time I had an attack, the doctor still had to check an ECG. My second aunt and my second aunt’s husband would sometimes tell me that doctors nowadays, just to make money, I told him it was cholecystitis. I told him it was cholecystitis. There are several more tests, no wonder hospitals are rich.
It is wrong, for the second aunt this idea, the doctor who treats him is exactly good heart meet donkey liver lung. Sometimes very helpless, ignorant of medicine, Aunt Yee reflects the thoughts of many people.
Aunt Er, each attack, and most of the previous related, but not necessarily certain, so, check the ECG is very necessary. If this missed diagnosis of pain is due to the heart, it will be too late.
This is a treatment routine, not what the doctor wants to charge. Doctors are so busy every day that they would like to do a few less tests, and a total of 20 yuan for a test, which does not earn much money at all.
I deeply feel that diseases are well treated, but it is difficult to change people’s philosophy.
Aunt Er is a typical patient with gallbladder disease, meeting three etiologies, with the manifestation of biliary stasis, later forming gallstones, then later forming cholecystitis, which has had acute attacks and is currently at the stage of chronic cholecystitis.
Treatment of gallbladder disease
Then you see how I can be better treated for this disease. I have taken too many medications, and it always goes back and forth.
I felt the aggressive sound of my second aunt’s voice tightening her brow through the phone.
Sorting out the history of the disease, and the current situation, we should treat it this way.
First of all, second aunt, in fact, you can leave this disease untreated.
Ah, don’t you fool me, how could it be untreated?
Because you are now symptom-free and in a period of calm.
So will this disease happen again?
Because there are gallstones, there is a good chance that it will happen again.
Is there no cure?
This question is really hard to answer.
First of all, it is a case of biliary stasis. If Aunt Er you just have a biliary stasis and no stones or cholecystitis, you can leave it untreated because there is not much harm. If there are symptoms that affect your life, you can consider using cholagogic drugs, classically using ursodeoxycholic acid preparations.
If there are gallbladder stones, then the main strategy is to treat gallstones cholecystitis, this cause is removed, and the bile accumulation will be well.
Treatment of cholecystitis
For the treatment of cholecystitis, I think you know very well, second aunt.
Acute pain will be cured by injection and infusion.
How can it be that simple? You should know that the treatment of the disease does not depend only on injections and medication, but also on comprehensive treatment in many aspects.
The first is the basic treatment. Basic treatment is the treatment in life
Life is regulated, pay attention to the combination of work and rest, appropriate temperature and cold, maintain optimism and smooth bowel movement. Maintain the left side of the bed frequently, which is conducive to bile excretion. Low-fat meals should be chosen to reduce bile secretion and the burden on the gallbladder.
Drug treatment.
The principles of acute attacks are, anti-inflammatory, analgesic and biliary.
(1) Acute attack of acute cholecystitis ① antispasmodic and analgesic Intramuscular injection of atropine, sublingual nitroglycerin, pethidine (dulcolax), etc. can be used to release the spasm and pain of the sphincter of Oddi. ② Antimicrobial therapy Antibiotics are used to prevent bacteraemia and
The combination of ampicillin (aminobenzyl penicillin), clindamycin (clindamycin) and aminoglycosides, or second-generation cephalosporins such as cefamandole (cefadroxil) or cefuroxime is usually used.
Treatment. The change of antibiotics should be based on blood culture, bile culture at the time of surgery and bacterial culture of the gallbladder wall, as well as the results of drug sensitivity tests. (3) Biliary medications: 50% magnesium sulfate orally (not used in those with diarrhea), dehydrocholic acid tablets orally, and bile acid tablets orally.
(2) The usual chronic cholecystitis does not require treatment if there are no symptoms, and symptomatic treatment can be considered if there are symptoms. Symptomatic drugs and choleretic drugs are usually used.
Surgical treatment
Cholecystectomy is the fundamental treatment for acute cholecystitis. Indications for surgery: (1) gangrene and perforation of the gallbladder with diffuse peritonitis; (2) repeated acute attacks of acute cholecystitis with a clear diagnosis; (3) continued development and deterioration of the disease after active medical treatment; (4) no contraindications to surgery and those who can tolerate surgery. In chronic cholecystitis with gallstones; once the diagnosis is established, cholecystectomy is a reasonable and fundamental treatment. If the patient has serious diseases such as heart, liver, lung or other systemic conditions that cannot tolerate surgery, internal medical treatment is still required.
Second
Auntie has not had her gallbladder removed because she is worried about the impact of surgery. For aunt Er’s case with a longer onset and recurrent attacks, gallbladder removal can be considered, however, it is not yet the best indication.
We generally think it’s better to be conservative than not to have surgery, our own organs are useful, and the consequences of removing them, some of which we already know, but sometimes we don’t know what other effects there are.
In fact, when the gallbladder infection is recovered, the important thing is to treat the most important primary disease – gallstones.
Second Aunt, the key to your disease is gallbladder stones.
Can gallbladder stones be cured? The answer is yes, they can!
But the treatment is invasive and the means of treatment itself can bring complications and adverse reactions, and there is no surgical method that is foolproof. So, we have to wrestle with the question of whether to take a knife to gallbladder stones.
The current best treatment
1. Prefer laparoscopic cholecystectomy treatment
Less damage than the classical open cholecystectomy, the efficacy is exact. Small incision cholecystectomy can be performed without laparoscopic conditions. Asymptomatic gallbladder stones generally do not require active surgical treatment and can be observed and followed up, but surgical treatment should be considered in the following cases.
(1) stone diameter ≥ 75px.
(2) Combined surgery requiring open abdomen.
(3) associated with gallbladder polyps >25px.
(4) thickening of the gallbladder wall.
(5) calcification of the gallbladder wall or porcelain gallbladder.
(6) gallbladder stones in children.
(7) Combined diabetes mellitus.
(8) Cardiopulmonary dysfunction.
(9) remote or underdeveloped transportation areas, field workers
(10) Gallbladder stones found for more than 10 years.
Second Aunt’s status is 1, 4, 10
accounted for 3 items, so Aunt Yee did not choose this treatment.
Many gallbladder stones do not require surgical treatment, just treat them as a gift from God, cherish them carefully, and carry them with you every day, which is also the concept of coexistence with disease and the essence of the idea of “harmony” in Chinese medicine.
Turning
Turning enemies into friends, or living in harmony, is the idea behind the treatment of many diseases, from tumors to bacteria and antibiotics, and the treatment of heart failure. It is possible to live a better life if one maintains a calm mind and allows the body to be imperfect.
well, although we cannot achieve a cure for our diseases and our bodies are not strong enough to be intact, we can live better. And there is no need to dwell on the daily struggle with illnesses, relax and
live with them.
Chinese Medicine Treatment
Chinese medicine can play a more important role in this process of living with illness.
Huang Lian Wen Bile Tang is the basic prescription of choice for all kinds of gallbladder diseases. It is also the formula of choice for my second aunt’s long-term regimen.
The name is to warm the gallbladder, but in reality it is to cleanse it. The basic prescription is based on “Er Chen Tang”, which is the first basic prescription in Chinese medicine to resolve dampness.
Fuxianxia 9, Chen Pi 12, Fu Ling 15, Huang Lian 6
Bamboo rhizome 10 Citrus aurantium 10 Roasted licorice
These
7 herbs
These seven herbs constitute the core echelon of the treatment of gallbladder diseases in Chinese medicine, of which, the best combination of Radix Panax, Pericarpium Citri Reticulatae and Poria is the best combination for resolving dampness, which is the fundamental treatment of the disease.
The medicine is the driving force to activate the action of the drugs, that is, the “errand boy” of the drug team, while licorice, as the enabling medicine, has to harmonize the action of each drug, which is a liaison, and is also the secretary of the whole formula. The role of this team
The role of this team is to relieve the effect of bile stagnation through the synergistic effect of resolving dampness, clearing heat and regulating qi.
Huanglian Wenzhi Tang is the first-line medicine for the state of biliary stasis and the preferred team.
If there are other symptoms, such as thin stools, call for fried Atractylodes; if there is fatigue from Qi deficiency, add roasted Astragalus and prunus ginseng, etc., adjusting with different symptoms.
For Aunt Er, you can usually take the formula based on Huang Lian Wen Biao Tang to relieve symptoms when you have symptoms.
Can’t you be completely cured by taking this medicine?
No, Aunt Yee, because you still have gallstones. What should I do then?
If there is no attack, if you live peacefully with gallstones and there is no attack of cholecystitis, just use Huang Lian Wen Bile Tang.
If there are gallstones combined with acute cholecystitis, the TCM protocol is to add Da Chai Hu Tang, which is another treatment team, a rapid response force for acute cholecystitis in TCM.
In chronic cholecystitis, Xiao Chai Hu Tang and Si Wei San can be added.
These treatments, in some patients, can achieve a radical cure because, in the case of gallstones, a portion of the smaller, less adherent small stones can be expelled through the digestive tract with medication and their own efforts, which need to be seen on a case-by-case basis.
While a part of the patients cannot achieve the goal of stone removal by medication, then the purpose of taking herbs for this part of the patients is to relieve the symptoms, which is what Aunt Er is doing. Unfortunately, although she did not achieve the goal of expelling her stones by means of Chinese medicine after several treatments, she has understood the disease before and after and decided to live peacefully with the stones.
In fact, it is very rare and fortunate to achieve a clinical cure. However, it is not always possible to achieve a cure, it is always possible to go into remission, and it is often impossible to do so.