I. Disease Overview
Gallbladder stones are mainly cholesterol stones or cholesterol-based mixed stones. Gallbladder stones are mainly seen in adults and are common in women, especially in menstruating mothers and those taking birth control pills.
Clinical manifestations
Gallbladder stones cholelithiasis cholecystolithiasis symptoms depend on the size and location of the stones, as well as the presence of obstruction and inflammation. About 50% of patients with gallbladder stones are asymptomatic for life, which is called occult stones. Larger gallbladder stones may cause symptoms of indigestion such as stuffiness and distension in the upper or right side of the abdomen, belching and aversion to fatty foods. Smaller stones may cause biliary colic and acute cholecystitis when they obstruct the gallbladder duct after a full meal, eating fatty food, or lying down at night. Due to the contraction of the gallbladder, smaller stones may pass through the cystic duct into the common bile duct and cause obstructive jaundice, then some stones may be discharged from the bile duct into the duodenum, and some stones remain in the bile duct as secondary bile duct stones. Stones may also obstruct the bile duct for a long time without infection and only form a fluid in the gallbladder, at which point an enlarged gallbladder without obvious pressure can be palpated. In the absence of infection, gallbladder stones usually have no specific signs or only mild pressure pain in the right upper abdomen. However, when there is an acute infection, pressure and muscle tension in the mid-upper abdomen and right upper abdomen may be present, and sometimes an enlarged and painful gallbladder may be palpable. Murphy’s sign is often positive.
Diagnostic differentiation
If there is a history of acute attack of gallbladder stones, it is generally not difficult to make a diagnosis based on clinical manifestations. However, if there is no history of acute attack, the diagnosis mainly relies on auxiliary examinations such as ultrasound examination which can show the light mass in the gallbladder and the sound shadow behind it, and the correct diagnosis rate can be more than 95%.
IV. Treatment and prevention
(A) Surgical treatment
Cholecystectomy has good therapeutic effect. Because of the possibility of secondary bile duct stones, the common bile duct should be explored intraoperatively when the following indications are present. Absolute indications for exploration: ①Stones are found in the common bile duct; ②Cholangitis and jaundice are present at the time of surgery. Intraoperative cholangiogram showing bile duct stones; dilated common bile duct with a diameter of more than 12 mm, but in rare cases the bile duct is dilated without the presence of stones. The positive rate of this point at common bile duct exploration is only about 35%. In addition, there are some relative indications for exploration: (1) past history of jaundice; (2) small stones in the gallbladder; (3) chronic atrophic changes in the gallbladder; (4) history of chronic recurrent pancreatitis.
(B) Lithotripsy treatment
The main mechanism of gallbladder stone formation is the change of bile physicochemical composition, the reduction of bile acid pool and the increase of cholesterol concentration. In 1972, Danjinger firstly applied goose deoxycholic acid and succeeded in dissolving cholesterol stones in 4 cases of gallbladder. However, this drug has certain toxic reactions on the liver, such as an increase in ghrelin, and can irritate the colon and cause diarrhea. At present, the main drugs for lithotripsy are goose deoxycholic acid and its derivative ursodeoxycholic acid. Indications for treatment: ① gallbladder stones less than 2 cm in diameter; ② gallbladder stones with little calcium that can be transmitted by X-ray; ③ gallbladder duct patency, i.e. a functional gallbladder can be shown on oral cholecystography; ④ the patient’s liver function is normal; ⑤ there is no obvious history of chronic diarrhea. The therapeutic dose is 15 mg/g per day for 6 to 24 months. The efficiency of stone dissolution is generally 30-70%. Ultrasound or oral cholecystography was performed once every six months during the treatment period to understand the dissolution of stones. Since the value of such lithotripsy drugs is expensive, and there are certain side effects and toxic reactions, and must be taken for life, if 3 months after stopping the drug, the cholesterol in the bile will become supersaturated again, and the stones will recur, according to statistics, the recurrence rate of 3 years can reach 25%, there are still some limitations of such lithotripsy treatment. In addition, some new drugs, such as Rowachol and metronidazole, also have some lithotripsy effect. The combined application of phenobarbital and goose deoxycholic acid often increases the lithotripsy effect.
(iii) Extracorporeal shock wave lithotripsy
The main indications for the treatment of gallbladder stones by shock wave lithotripsy are cholesterol stones in the gallbladder, negative stones on oral cholecystography, no more than 3 stones in the diameter of 12-15 mm, and only 1 stone in the diameter of 15-20 mm, and a normal gallbladder contraction. Zhongshan Hospital of Shanghai Medical University has applied EDAP-LT 01 shock wave lithotripter to treat 687 gallbladder stone cases since January 1988, and the stone crushing rate was 98%. The disappearance rate of gallbladder stones 1, 2, 3, 4 and 6 months after one shock wave treatment was 27%, 33%, 40%, 45% and 50%, respectively. The side effects after treatment were mild, such as vague discomfort in the right upper abdomen (45%), biliary colic (16%) and weakness, and no complications of organ damage to the liver, bile, pancreas and gastrointestinal tract were observed.
In order to improve the disappearance rate after stone crushing, ursodeoxycholic acid (UDCA) 8 mg/kg/d was administered before and after the shock wave to achieve the synergistic effect of stone crushing and lithotripsy. To consolidate the efficacy after the disappearance of stones, it can be continued for six months. This method is safe and effective, but there is still about 11.2% stone recurrence rate, expensive treatment, and strict treatment scope, which are all shortcomings.
V. Dietary attention
1. Prohibit alcohol and alcoholic beverages
2.Eating regularly, breakfast should be good
3, low cholesterol diet. Excessive cholesterol intake can increase the metabolic and cleaning burden of liver and gallbladder, and cause excess cholesterol to crystallize, accumulate and precipitate in the gallbladder wall, thus forming stones, so cholesterol intake should be reduced, especially at night, and high cholesterol foods such as eggs (especially egg yolks), fatty meat, seafood, scaleless fish, animal offal and other foods should be avoided.
Six, other dietary considerations.
1, it is advisable to eat a variety of fresh fruits and vegetables, into low-fat, low-cholesterol foods such as: mushrooms, fungus, celery, bean sprouts, kelp, lotus root, fish, rabbit, chicken, fresh beans, etc..
2.It is advisable to eat more dry beans and their products.
3.It is advisable to use vegetable oil, not animal oil.
4, eat less chili, raw garlic and other stimulating food or spicy food
5.It is advisable to use cooking methods of boiling, steaming, braising, stir-frying, mixing, blanching, stewing, without oil frying, deep-frying, baking, smoking cooking methods.
6, hawthorn 10 grams, hang chrysanthemum 10 grams, cassia seeds 15 grams, decoction for tea or drinking green tea.
7, usually drink water, pinch a little hawthorn, sea buckthorn, ginkgo, gibberellic acid grass into the water cup as tea.