Cholelithiasis is a kind of coagulation formed in the bile duct tree (including gallbladder), and it is one of the most common digestive system diseases in clinic. The main clinical manifestations are paroxysmal abdominal pain and acute inflammation. If stones enter the common bile duct, the following complications may occur: jaundice, cholangitis and pancreatitis. But most patients have no symptoms.
The main reasons why gallstones think that "women are more important than men" may be:
1. Quiet, quiet. Many women, especially middle-aged women, often spend more time at home and less exercise and physical labor. Over time, the contractility of their gallbladder muscles will inevitably decrease, and bile emptying will be delayed, which will easily lead to cholestasis and cholesterol crystallization, creating conditions for the formation of gallstones. In addition, due to the high level of estrogen in women, it will affect the formation of bilirubin glucuronide in the liver and increase unbound bilirubin. Estrogen will affect gallbladder emptying, cause bile sweat stagnation and promote the formation of stones. The incidence of gallstones in postmenopausal women who use estrogen has increased significantly.
2. Obesity. Many women usually like to eat drinks or snacks with high fat, high sugar and high cholesterol. The direct result of this hobby is that they gain weight, and obesity is an important basis for gallstones. Studies have shown that the incidence of gallstones is five times higher in people whose weight exceeds the normal standard 15%. Fat women over 40 years old have the highest incidence of gallstones. At this time, female estrogen will make cholesterol accumulate more in bile.
3. Don't eat breakfast. I'm afraid more modern women skip breakfast than eat breakfast. Long-term skipping breakfast will increase bile concentration, which is conducive to bacterial reproduction and easy to promote the formation of gallstones. If you insist on eating breakfast, you can promote the outflow of some bile, reduce the viscosity of bile stored overnight and reduce the risk of gallstones.
4. Multiple pregnancy. During pregnancy, women's biliary tract function is prone to disorder, resulting in weak contraction of smooth muscle and bile retention in the gallbladder. In addition, the cholesterol in the blood during pregnancy is relatively high, which is easy to precipitate, and the probability of forming gallstones is greatly increased, and the incidence rate of prolific women is higher.
5. Snacks after meals. Now many families in our country can see this situation. After dinner, the family sat leisurely on the sofa, chatting and watching TV while eating snacks. This habit of sitting and eating snacks after meals may be one of the reasons for the increasing incidence of gallstones in China. When people are in a curled posture, the intra-abdominal pressure increases and gastrointestinal peristalsis is limited, which is not conducive to the digestion and absorption of food and bile excretion. Sedentary after meals hinders the reabsorption of bile acids, leading to the imbalance between cholesterol and bile acids in bile, and cholesterol is easy to deposit.
6. People with liver cirrhosis. This is related to the decline of estrogen inactivation function in patients with liver cirrhosis. If the estrogen inactivation function in the body is reduced, the estrogen level will be higher. In addition, many factors, such as low gallbladder contraction function, poor gallbladder emptying, varicose bile veins, and elevated bilirubin in blood, can cause gallstones.
7. Genetic factors. Genetic factors obviously play an important role in determining the risk of gallstones. Gallstones are more common in close relatives of patients with cholesterol stones. Local Americans in the southwestern United States are at high risk of cholesterol gallstones (>: 80%), which seems to contain a genetic factor.
[Edit this paragraph] Canceration
Gallstones are the cause of gallbladder cancer. The gallbladder is stimulated by chronic inflammation and cholic acid and choline in gallstones for a long time, which is easy to cause canceration of gallbladder mucosa. Because gallbladder cancer patients often have gallstones, they are often misdiagnosed in diagnosis.
Malignant tumor of bile duct (cholangiocarcinoma) can occur anywhere along the bile duct tree, with the peak age of 60-65 years old, mainly manifested as jaundice, occasional pain and weight loss. Risk factors of cholangiocarcinoma include clonorchiasis, congenital cystic dilatation of bile duct, sclerosing cholangitis and ulcerative colitis. The clinical manifestations and diagnosis of gallbladder cancer are similar to those of cholecystitis, and it is often found by accident during cholecystectomy. 90% of gallbladder cancer is adenocarcinoma. The one-year survival rate was only 14%.
80% ~ 90% of gallbladder cancer is related to gallstones, and the risk factors of gallbladder cancer are mostly the same as gallstones. Some native Americans have a genetic tendency, and the frequency of gallstones is high when they are young. The incidence of gallbladder cancer is 5- 10 times that of the general population. The duration and severity of gallstones are related to the risk factors of gallbladder cancer. Gallbladder cancer is especially associated with large stones (diameter > 100mm); 3cm) or calcification of gallbladder wall with chronic inflammation (porcelain gallbladder), so these findings are considered by many experts as indications for cholecystectomy, even for asymptomatic patients. However, because the incidence of gallbladder adenocarcinoma in patients with gallstones is less than L/ 1000, the prevention of gallbladder cancer is not an indication for cholecystectomy in most patients with asymptomatic gallstones.
[Edit this paragraph] Prevention
Diet control is the most ideal method to prevent gallstones and gallbladder cancer. To prevent gallstones, we should pay attention to diet regulation, and the diet should be varied. In addition, cold, greasy, high-protein, irritating foods and spirits are easy to help damp heat and cholestasis, so we should eat less.
This also reminds everyone from the opposite side that although the living conditions are constantly improving, the gatherings between relatives and friends are gradually increasing. Many people have many opportunities to "eat big meals" during festivals, and the frequency of eating big fish and meat is also very high. Excessive drinking and obesity have become the main causes of gallstones and other gallstones. Some men who are often busy socializing, staying up all night and traveling for a long time may even suffer from kidney calculi. Experts believe that people around the age of 40 have different degrees of stones, but small stones can be gradually discharged through their own excretory function. As long as you pay attention to a reasonable diet, most of you can avoid the pain of stones and surgery.
Vegetables, fruits, fish and seafood rich in vitamin A and vitamin C are helpful for clearing gallbladder, promoting diuresis and dissolving stones, so you should eat more.
It is also important to have a regular life, pay attention to the combination of work and rest, often participate in sports activities, eat breakfast on time, avoid getting fat and reduce the number of pregnancies. Drinking a glass of milk or eating an fried egg for breakfast every night can make the gallbladder contract and empty regularly and reduce the residence time of bile in the gallbladder.
Recent studies have also found that nut intake seems to reduce the risk of gallstones. Most of the fat in a healthy diet comes from nuts.
The reasons for the formation of gallstones are complicated, but the changes of bile components, especially the changes of bile salts and cholesterol, are important factors for the formation of gallstones. Under normal circumstances, they keep a certain proportion in bile. Cholesterol is dissolved and excreted with bile. If there is too little bile salt or too much cholesterol, the normal proportional relationship between them will be lost, cholesterol will be supersaturated, and too much cholesterol in bile will precipitate to form stones.
If there are inflammation, ascaris eggs, necrotic tissue and bile pigment in the gallbladder at the same time, it is easier to form stones. However, sugar can stimulate islet β cells to secrete insulin, increase cholesterol, lead to supersaturation of cholesterol in bile and promote the formation of gallstones.
The diet of 267 patients with cholelithiasis and 600 healthy people was investigated and analyzed. The results show that the more sugar you eat, the higher the incidence of cholelithiasis.
Therefore, to prevent the occurrence of gallstones, we must reduce blood sugar.
The above prevention of gallstones is summarized as follows:
(1) Regular diet (three meals a day) is the best way to prevent stones, because the gallbladder is full of bile on an empty stomach, and the gallbladder mucosa absorbs water to thicken the bile. At this time, cholesterol/lecithin vesicles are easy to form bile, and the viscosity is also increased, and finally bile mud is formed. If you overeat, when food enters the duodenum, it will reactively secrete cholecystokinin, which will make the gallbladder contract. At this time, a large amount of viscous and turbid bile is discharged into the intestine. Therefore, the formation of stones can be prevented.
(2) Choose a reasonable diet structure and avoid eating habits of high protein, high fat and high calorie. Eating a diet rich in cellulose properly can improve cholesterol excretion and prevent the formation of stones.
(3) Maintain the contractile function of gallbladder and prevent bile from long-term stagnation. Long-term fasting patients who use intravenous nutrition, such as cholecystokinin.
(4) Actively treat some primary diseases that can cause gallstones, such as hemolytic anemia and cirrhosis, because these diseases are easy to induce gallstones.
Hepatolithiasis is mostly composed of yellow-green massive or "sediment-like" stones, mostly calcium bilirubin. Ascaris eggs are often seen in the center of stones, so some doctors think that intrahepatic bile duct stones are caused by biliary ascaris and bacterial infection.
Intrahepatic lithiasis is mostly in the left lobe of the liver, and the bile duct at the junction of the upper and lower segments of the left lateral lobe of the liver is slightly thickened, and stones are mostly left there. Right hepatolithiasis is more common in the right posterior lobe of the liver. Clinical features are as follows:
(1) patients are younger than those with gallstones, and some patients are related to congenital anomalies of intrahepatic bile duct. Patients often have a history of recurrent abdominal pain, chills, fever and jaundice since childhood.
(2) Liver function is damaged and gallbladder function may be normal. There are many abnormalities in liver function during recurrent attacks, and alkaline phosphatase increases during intermittent attacks; Long-term illness will lead to liver lobe atrophy and liver fibrosis.
(3) Abdominal pain, jaundice and fever are the main symptoms, but typical severe colic rarely occurs.
(4) There are many and serious complications. Common diseases include suppurative intrahepatic cholangitis, liver abscess and biliary bleeding.
(5) Cholangiography can show intrahepatic bile duct dilatation without extrahepatic bile duct dilatation, and there is a small transparent area in the hepatic duct.
[Edit this paragraph] Dietary therapy for gallstones
The reasons for the formation of gallstones are complicated, but the changes of bile components, especially the changes of bile salts and cholesterol, are important factors for the formation of gallstones. Under normal circumstances, they keep a certain proportion in bile. Cholesterol is dissolved and excreted with bile. If there is too little bile salt or too much cholesterol, the normal proportional relationship between them will be lost, cholesterol will be supersaturated, and too much cholesterol in bile will precipitate to form stones.
If there are inflammation, ascaris eggs, necrotic tissue and bile pigment in the gallbladder at the same time, it is easier to form stones. However, sugar can stimulate islet β cells to secrete insulin, increase cholesterol, lead to supersaturation of cholesterol in bile and promote the formation of gallstones.
The diet of 267 patients with cholelithiasis and 600 healthy people was investigated and analyzed. The results show that the more sugar you eat, the higher the incidence of cholelithiasis.
Therefore, to prevent the occurrence of gallstones, we must reduce blood sugar.
Pay attention to food hygiene and avoid parasitic infection.
Appropriate low-fat diet, eat more fresh vegetables, fruits, edible lean pork, chicken and duck egg whites, etc.
Do not eat fried food, animal fat and internal organs, and pay attention to eating egg yolk, fish and crustaceans.
Avoid alcohol, tobacco and spicy food.
Diet regulation
The purpose of diet therapy is to inhibit the formation of stones and alleviate the pain caused by stone obstruction. The principle of diet therapy is:
The heat supply should meet the physiological needs, but it should be prevented from being excessive, which is generally 1500 ~ 2400 kcal.
Restrict fat and avoid stimulating gallbladder contraction to relieve pain. Before and after the operation, the fat in the diet should be controlled at about 20 grams, and it can be slightly increased with the improvement of the condition to improve the color, aroma and taste of the dishes. Avoid greasy, fried, fried and fatty foods, such as fat pork, mutton, stuffed duck, fat goose, butter, cakes and cream cakes.
[Edit this paragraph] Ten ways to prevent gallstones by diet
1 Drink plenty of water and don't hold your urine.
Don't hold your urine. Drinking more urine will help bacteria, carcinogens and calculus-prone substances to be excreted quickly and reduce the chance of kidney and bladder damage.
Drink less beer.
Some people think that beer can induce diuresis and prevent urinary calculi. In fact, wort for brewing beer contains acidic substances such as calcium, oxalic acid, uridine and purine nucleotide, which can increase uric acid in human body and become an important inducement of kidney calculi.
Eat less meat and animal offal.
Control the intake of meat and animal viscera, because meat metabolism produces uric acid, and animal viscera is high purine food, and catabolism also produces high blood uric acid, and uric acid is the component that forms stones. Therefore, the daily diet should be mainly vegetarian and eat more foods rich in cellulose.
4 eat less salt
Too salty diet will increase the workload of the kidneys, and salt and calcium have a synergistic effect in the body, which can interfere with the metabolic process of drugs for preventing and treating kidney calculi. The daily intake of salt should be less than 5g.
5 be careful to eat spinach
According to statistics, more than 90% stones contain calcium, and calcium oxalate stones account for about 87.5%. If there is too much oxalate in food and the calcium oxalate in urine is supersaturated, excess calcium oxalate crystals may precipitate from urine and form stones. Among foods, spinach has the highest oxalate content, and spinach is one of the vegetables that people often eat?
Don't drink milk before going to bed
Because milk contains more calcium, most stones contain calcium. The most dangerous factor of stone formation is the sudden increase of calcium concentration in urine in a short time. 2 ~ 3 hours after drinking milk is the peak of calcium elimination through the kidney. At this time, it is in a state of sleep, urine is concentrated, and calcium passes through the kidney more, which is easy to form stones.
7 it is not advisable to eat more sugar.
After taking sugar, the concentration of calcium ion, oxalic acid and uric acid in urine increased, and the degree of uric acid increased, which made calcium urate and calcium oxalate easy to precipitate and promoted the formation of stones.
8 eat dinner early
The peak of calcium excretion is usually 4-5 hours after eating. If you eat dinner too late, when the peak of calcium excretion comes, people have gone to bed and fallen asleep, and urine will remain in the urinary tract such as ureter, bladder, urethra, etc., which will not be excreted in time, resulting in an increasing calcium content in urine and easy deposition to form small crystals. Over time, it will gradually expand to form stones.
Eat more vegetables and fruits.
Vegetables and fruits contain vitamin B 1 and vitamin C. Their final metabolites in the body are alkaline, and uric acid is easily dissolved in alkaline urine, so it is beneficial to the treatment and prevention of stones.
10 Reduce the intake of protein.
Studies have shown that a high-protein diet will increase the incidence of urinary calculi. Therefore, controlling protein in food, especially protein, is beneficial to all patients with stones.
[Edit this paragraph] Who is prone to gallstones?
A: Cholelithiasis is a common disease, and the incidence rate in China is about 15%. Medical research has found that the following people are more likely to suffer from gallstones.
1, 70% of gallstone patients are women, and the more pregnancies, the higher the incidence. The reason is that the high level of estrogen in women will affect the formation of liver glucuronic bilirubin and increase unbound bilirubin; Estrogen can also affect gallbladder emptying, causing gallbladder sweat stagnation and easy to form stones. The incidence of gallstones in postmenopausal women who use estrogen is increasing. The incidence of gallstones in obese people whose weight is over the normal standard 15% is five times that of their peers with normal weight, and that of obese women aged 20-30 is six times that of their peers with normal weight. 40% of obese women over 60 years old suffer from gallbladder diseases and gallstones. The reason is that most obese people eat too much fat and cholesterol, and most obese people exercise less and are prone to gallstones.
2, the diet is sweet, and its fat and cholesterol intake are more, which is easy to form cholesterol stones. Too many sweets will promote insulin secretion and accelerate cholesterol deposition.
3, often not eating breakfast will reduce the content of cholic acid, bile sweat concentration, which is conducive to the formation of stones.
4. Ascaris infected people do not pay attention to food hygiene. Ascaris infection will become the core of stones and produce stones after it returns to biliary tract to lay eggs or dies.
5. The incidence of gallstones in patients with liver cirrhosis is significantly higher than that in normal people, which is related to many factors such as decreased estrogen inactivation function in patients with liver cirrhosis, decreased estrogen inactivation function in vivo, increased estrogen level in vivo, chronic hemolysis, low gallbladder contraction function, poor gallbladder emptying, biliary varices, increased bilirubin in blood and so on.
[Edit this paragraph] Common sense of multiple gallstones
A large number of patients with gallstones are asymptomatic, which we call "hidden gallstones" and "asymptomatic gallstones", also known as "gallbladder resting stones". This situation is often found by accident in health examination or diagnosis and treatment of other diseases, and has often turned into multiple gallstones.
Diagnosis of multiple gallstones;
The diagnosis of multiple gallstones is generally based on the medical history, such as right epigastric pain, right shoulder radiation, fever and other symptoms, and then diagnosed by B-ultrasound, which can clearly show the gallbladder, and the diagnostic rate of gallstones is as high as 95%. Therefore, for patients suspected of having gallstones, B-ultrasound is generally used for definite diagnosis.
Prevent multiple gallstones;
Because of stones, you should control a lot of mouths, such as wine and alcoholic drinks, and eat regularly and have a good breakfast. Excessive intake of cholesterol will increase the metabolism of liver and gallbladder and the burden of cleaning up, so that excess cholesterol will crystallize, accumulate and precipitate in the gallbladder wall, thus forming stones. Therefore, patients with gallbladder polyps should reduce their cholesterol intake, especially at night, and avoid eating high-cholesterol foods such as eggs (especially egg yolks). Eat less spicy or irritating foods such as peppers and raw garlic. When drinking water at ordinary times, pinch a little hawthorn, seabuckthorn, ginkgo leaf and Gynostemma pentaphyllum into a cup to make tea.
Treatment of various forms of gallstones;
The lithotripsy of polymorphic gallstones is a mechanical shock wave (shock wave) produced by the lithotripsy instrument. This kind of shock wave advances with sound waves, with high energy and pressure, which can break stones in the human body. This is mainly due to the anatomical factors of the biliary system itself. Broken stones in the gallbladder must first be discharged into the common bile duct through the cystic duct with the help of gallbladder contraction function. Under the pressure of common bile duct and bile flow, the crushed stone will be discharged into duodenum through Oddi sphincter. Even if the lithotripsy is successful, it will cause a series of complications if it is blocked in the process of lithotripsy. Generally speaking, people with opaque bile duct stones, huge stones (more than 3 cm in diameter), gallbladder dysfunction, bile duct stenosis or blockage are not suitable for lithotripsy, otherwise it will not only fail to achieve the good purpose of lithotripsy, but will bring unnecessary pain and economic losses to patients.
[Edit this paragraph] Treatment of gallstones
At present, there are many treatments for gallstones: surgical treatment, extracorporeal shock wave lithotripsy and so on. For a certain kind of stone, although the above methods have certain curative effect, they can't avoid stone residue and stone regeneration. The effect of "stone-removing method in childbirth" is very exact, which solves this problem. A large number of clinical observation results show that it has four functions: relieving pain, removing calculus, diminishing inflammation and promoting gallbladder function. At the same time, it has the advantages of quick onset, good curative effect, short course of treatment and no contraindications, and is the first choice for patients with gallstones.
Q: What is the "stone extraction method in childbirth"?
A: Lithotripsy during childbirth, also known as bile duct dilatation, is a vivid description of the process of lithagogue by Chinese medicine carefully developed by Dr. Wang Changgen and Qiandantong oral liquid. The whole process is similar to that of a woman giving birth to a child. Comprises the following steps: after taking traditional Chinese medicine and Qian Qian Tongdan, bile secretion is increased, and at the same time, the gallbladder is contracted under the action of the medicine, so that pressure is generated to displace stones, and stones are gradually pushed to the mouth of the common bile duct, and at this time, the mouth of the common bile duct is relaxed, which is beneficial to the discharge of stones. The whole process has been verified in animal model. This kind of therapy is non-invasive, without hospitalization, surgery and taboo (chicken, duck, meat, eggs, rice cakes, zongzi, etc. ) special therapy, no toxic side effects. It can not only remove stones, but also eliminate gallbladder inflammation, restore gallbladder function, normal bile secretion of liver and restore liver function.
Q: What are the indications of "stone-discharging method in childbirth"?
A: Gallbladder stones; Common bile duct stones; Intrahepatic bile duct stones; Residual stones and regenerative stones after biliary tract surgery; Obstructive jaundice caused by stones; Chronic cholecystitis, etc.
Q: What are the characteristics of "stone-removing method in childbirth" in treatment?
A: The method of "removing stones during childbirth" has five characteristics:
1, quick stop:
Cholelithiasis can cause severe colic, sometimes radiating to the shoulder and back, and may be accompanied by symptoms such as nausea and vomiting. In the past, conventional anti-inflammatory and antispasmodic treatments can only temporarily relieve symptoms, but can't do anything about recurrent pain, which makes patients extremely painful. Traditional Chinese medicine and Qiandantong can exert analgesic effect within 5- 10 minutes after oral administration, and its analgesic effect is better than that of Demerol.
2, efficient stone discharge:
Intrahepatic bile duct stones are recognized as one of the difficult problems in modern medicine. Conventional treatment methods are often difficult to achieve satisfactory results. The traditional Chinese medicine and Qian Dan of "stone-removing method" have been personally verified by more than 400 thousand patients at home and abroad, and the stone-removing method is ahead of other imported and domestic drugs.
3, cholagogic and anti-inflammatory:
The symptoms of gallstones are often accompanied by acute and chronic cholecystitis. Once stones block the common bile duct, patients will have different degrees of jaundice (yellow staining of sclera and skin). On the one hand, stones can be discharged, bile ducts can be dredged, and jaundice naturally subsides rapidly after the use of traditional Chinese medicine and Qian Tongdan. On the other hand, traditional Chinese medicine and Qiandantong can promote the secretion of bile. Bile itself is the best "anti-inflammatory drug" for the liver and gallbladder, which also avoids excessive dependence on antibiotics and reduces the burden for patients economically.
4. No taboos:
Cholelithiasis patients must have strict diet control, which is almost called "common sense". Now, the introduction of Chinese medicine and Qian Tongdan's method of "expelling stones during childbirth" will break this "routine" and make many gallstone patients no longer "at a loss" when facing the temptation of food. Patients can eat chicken, duck, meat, eggs, rice cakes and zongzi with confidence whether in the treatment period or in the recovery period.
5, to prevent recurrence:
Cholelithiasis is a chronic disease that is difficult to be completely cured. After a period of treatment (including surgery), many patients suffer from relapse, enlarged stones, aggravated illness and unbearable pain. Traditional Chinese medicine and Qiandantong, which are used to expel stones during childbirth, can promote bile secretion, improve bile composition, reduce the chance of stone formation, and effectively prevent the further development and regeneration of gallstones.
Q: The method of removing stones by throwing stones is suitable for larger stones (diameter >; 1cm) effective?
Answer "valid. Experts have asserted that stones with a diameter exceeding 1 cm will not be pushed out. However, among more than 400,000 patients who successfully discharged stones with traditional Chinese medicine and Qian Tongdan, it is not uncommon to discharge stones with a diameter greater than 1cm. So, how is the "boulder" discharged? In fact, most stones (especially bile pigment stones) are soft in the tube. When the gallbladder contracts, gallstones are squeezed and deformed under pressure, and the whole process is similar to "squeezing toothpaste" through the loose bile duct. After gallstones are discharged from the bile duct and enter the intestine, they gradually form a "boulder" again under the peristalsis of the intestine.
Q: Is the method of "removing stones during delivery" effective for hepatolithiasis?
A: Effective. The main function of "stone-sending lithotripsy" to remove liver stones is to promote bile secretion. The flow of bile is like "scouring" the bile duct in the liver, and sediment-like stones are gradually discharged under the contraction of the gallbladder.
Correctly judge some special test results
1. It is generally believed that this examination has a high detection rate for gallstones, but some patients do have gallstones, but the results of the examination are that the gallbladder and bile duct are undeveloped or the stones are negative. This is because: (1) When severe liver dysfunction or highly obstructive jaundice occurs, the liver cannot excrete the contrast agent into the gallbladder and bile duct; (2) When the patient is obese, if the dose of contrast agent is insufficient, the gallbladder bile duct is slightly developed, and stones are not easy to see; (3) When suffering from digestive tract diseases such as pyloric obstruction, vomiting and diarrhea. If oral contrast agent is used, the contrast agent cannot be well absorbed and the development is often poor; (4) In the late pregnancy or lactation period, the contrast agent can easily enter the mammary gland, and the contrast agent in the gallbladder and bile duct can be reduced; (5) Due to some physiological or pathological reasons, the gallbladder bile duct is emptied too fast or filled too slowly, and the contrast agent has been emptied or has not yet entered the gallbladder bile duct when taking pictures; (6) The sphincter of Oddi relaxes, which leads to the decrease of pressure in bile duct. Bile and contrast agent directly flow into the intestine from the bile duct, not into the gallbladder, and there is little contrast agent in the bile duct; (7) For long-term vegetarians, bile accumulated in the gallbladder is not discharged, and new bile and contrast agent cannot enter the gallbladder; (8) When suffering from chronic cholecystitis, the thickening of gallbladder wall may affect the development clarity. In view of the above situation, if the gallbladder bile duct is underdeveloped or the stone is negative, if the above reasons cannot be ruled out, don't give up the possibility of gallstone diagnosis easily.
2. With regard to B-ultrasound, although the detection rate of gallstones can be as high as over 90%, it is not 100%. In other words, a few cases are still missed or false negative. The reasons are: (1) the stone is small or muddy, and the light mass and sound shadow are not obvious; (2) Because the stimulation of stones on the gallbladder wall can cause inflammation, the echo of gallbladder wall is also strong. If the sound beam projection angle is just behind the gallbladder wall with severe inflammation, the stone echo overlaps with the gallbladder wall echo, which can be mistaken for the gallbladder wall and missed diagnosis; (3) The gallbladder is hidden or in an abnormal position, which is not easy to find; (4) The gallbladder atrophy or stones fill the gallbladder, and the obvious difference between bile and stones in the gallbladder disappears, which makes the outline of the gallbladder blurred and the stones difficult to identify; (5) The gallbladder of obese people is often unclear; (6) When the sensitivity of the instrument is too high, especially when the far-field gain is too large, the echo of the tissues near the gallbladder will be enhanced, which is easy to interfere with the echo of stones; (7) The operator is inexperienced. Therefore, if the stone is negative by B-ultrasound, we should fully consider whether it is caused by one of the above reasons. Only by excluding these reasons can we make a negative diagnosis of stones.
3. With regard to CT scanning, the detection rate of gallstones by this method is not as high as that by combined cholangiography and B-ultrasound, because the gallbladder bile duct is a hollow organ and contains air, which may affect its inspection effect. Therefore, the existence of gallstones cannot be denied according to the negative results of CT scanning.
It can be seen that the above three special examinations (which are also the most important examination methods for gallstones at present) have certain limitations and cannot be relied on excessively. Only by fully understanding their limitations can we avoid or reduce missed diagnosis and misdiagnosis.
Beware of cases with atypical clinical manifestations
The atypical clinical manifestations of some cases of this disease are another reason for missed diagnosis or misdiagnosis. These cases mainly have the following manifestations.
1. No symptoms or signs. This type of patient (also known as static type) is mainly found by routine B-ultrasound examination during physical examination, and there are no symptoms and signs at ordinary times, so this kind of patient is easy to be missed.
2. There is no incentive to attack. Usually, the attack of biliary colic is often induced by eating greasy food, but we find that some cases have sudden onset and no inducement, and are often misdiagnosed as biliary ascariasis.
3. There is no pain in the right upper abdomen. The first or main symptom of cholelithiasis is colic in the right upper abdomen, but some patients have no pain in the right upper abdomen at the onset, and jaundice and high fever begin to appear. This situation mainly occurs in the elderly, which may be related to the physiological decline of the pain threshold of the elderly.
4. Jaundice gradually aggravates jaundice caused by gallstones. The general rule is that there are light and heavy, and there are ups and downs. However, some patients with jaundice have progressive aggravation, no remission and fluctuation, and are easily misdiagnosed as biliary system tumors, mainly due to stones blocking the bile duct and being tightly incarcerated.
5. Recurrent history of biliary colic is one of the important diagnostic criteria for this disease. But in some cases, the first attack of biliary colic is this disease, which is easy to be misdiagnosed as other acute abdomen, because recurrent biliary colic always has the first attack.
Doctors, patients and their families must be fully aware of these atypical cases and be vigilant. If we can think of these atypical manifestations in the clinical process, the misdiagnosis or missed diagnosis can be greatly reduced through the cooperation between doctors and patients and further in-depth examination.