Kuo Bule CPO Physiological Health Network
Reference:
Cholecystitis, Gallstones, and Fatty Diet ( Prof. Jia Yun Wu, Shanghai Medical University)
Cholecystitis and gallstones are common diseases. Most cases of cholecystitis occur due to the presence of stones in the gallbladder, which block the cystic duct, causing bile to be discharged ineffectively, followed by bacterial infection and the formation of cholecystitis. In some patients, there are no stones in the gallbladder, and bacteria enter the gallbladder from the intestines or from the blood circulation and form cholecystitis. Cholecystitis patients due to bile composition changes, bile concentration, with bacteria and inflammatory necrotic material as the core, but also prone to the formation of gallstones, so cholecystitis, gallstones often accompanied by the existence of.
Many people know that patients with cholecystitis and gallstones should avoid fat diet, why is this? After gallbladder surgery, is it still necessary to avoid fat diet? Why do some tests and treatments require some fat meals? To answer these questions, you first need to understand the anatomy and physiology of the gallbladder and bile ducts.
The gallbladder is a pear-shaped bag located below the liver, the liver produces an average of about 800 milliliters of bile per day, in addition to a small amount of bile flow directly into the duodenum, the vast majority of the gallbladder by the gallbladder after 10 times the concentration of the gallbladder stored in the gallbladder. When the gallbladder is contracted, the bile is squeezed from the gallbladder through the cystic duct into the common bile duct and into the duodenum to aid in the digestion and absorption of food.
When dietary fat enters the duodenum, it can stimulate the intestinal mucosa to release a kind of "cholecystokinin" substance, which causes the gallbladder to contract and excrete bile. However, if there are stones in the gallbladder or choledochal stones obstructing the normal discharge of bile, the strong contraction of the gallbladder can cause severe pain, and even induce cholecystitis or cholangitis attacks. Some of the gallbladder with bacteria in the body resistance to decline, can also be onset.
Because cholecystitis is accompanied by gallstones in the majority of patients, so patients suffering from cholecystitis and gallstones should avoid fat diets, so as not to induce pain and cholecystitis attacks.
The gallbladder is the place where bile is concentrated and stored, and patients who have had a cholecystectomy will have diarrhea when they eat fatty foods because there is no concentrated bile going into the duodenum to help them digest, and some of them will have diarrhea. In addition, after cholecystectomy patients, the common bile duct is often dilated to partially replace the function of the gallbladder. If the compensatory function of the bile duct is dysfunctional, symptoms similar to biliary colic can occur after eating a fatty diet, so patients after cholecystectomy should also avoid a fatty diet, at least for one to two years after surgery.
Patients with cholecystitis, gallstones, to understand the function of the gallbladder, need to take oral iopanoic acid or iodophenolic acid tablets and other drugs for cholecystography. The drug is excreted through the liver with the bile, into the gallbladder, concentrated, the gallbladder shadow can be shown on the X-ray film. After eating a fatty meal, if it shrinks to l/3 or l/4 of its original size within 30 to 40 minutes, the gallbladder function is normal. In patients with good gallbladder function, if there are only 1 to 2 stones, the size of which is within 2 centimeters, the method of extracorporeal shock wave lithotripsy can be used to make the large stones crumble into particles, and then take goose deoxycholic acid to dissolve the stones. At this time, the fat diet can cause the gallbladder to contract, and the crushed stones are discharged into the intestines along with bile, which is then excreted with the feces. Eating a fatty diet at this time is necessary for treatment. Therefore, understanding the anatomy and physiology of the gallbladder and bile duct, you can correctly understand the relationship between cholecystitis, gallstones and fat diet.
Shock waves can cure gallstones (Prof. Wang Bingsheng, Shanghai Medical University)
Gallstones are one of the most common diseases, and the traditional treatment is surgery. However, many patients would like to eliminate gallstones using non-surgical methods. The introduction of extracorporeal shock wave lithotripter has brought a blessing to some gallstone patients. The use of liquid electricity, piezoelectricity or magnetic effect made of extracorporeal shock wave lithotripter, can be sent outside the body of high-energy shock waves, through the human skin and tissues, the energy will be gathered in the stone site, so that the stone crushed, plus oral lithotripsy and cholagogue medication, so that the stone dissolved or discharged. This kind of treatment without surgery and painless, popular with the majority of patients.
However, not all patients with gallstones can be treated with extracorporeal shock wave therapy. Need to meet the following conditions in order to use this method of treatment: first, gallbladder stone diameter of less than 12 millimeters of 1 to 3, 13 to 20 millimeters of 1; second, oral cholecystography, the gallbladder concentration and contraction of the function is good, and is a small amount of calcium, through the X-ray of the negative stones; third, in the lithotriptic machine B-type ultrasound images, can clearly show the contour of the gallbladder and the location of the stone. In addition, stones in the common bile duct, right and left hepatic ducts, and limited intrahepatic bile ducts found after cholangiography can be treated with extracorporeal shock wave lithotripter if they can be shown on the ultrasound image of the lithotripter.
Shock wave treatment is not possible or is not suitable for those who have the following conditions. For example, the gallbladder is not visualized when oral cholecystography is administered, there are positive stones in the gallbladder with high calcium content that cannot pass through the X-ray, the diameter of a single gallbladder stone is greater than 25 millimeters, there are multiple stones in the gallbladder, gallbladder stones are accompanied by choledochal stones, and there are extensive intrahepatic choledocholithiasis.
After gallbladder stones are treated by shockwave therapy, ursodeoxycholic acid should continue to be taken for 3 months after the stones disappear. You should pay attention to your diet and eat less greasy and cholesterol-rich food. Regular ultrasound examination should be done to observe whether there is any stone regeneration, so that appropriate treatment measures can be adopted in time, which may include taking stone dissolving drugs, resuscitating shock treatment again or switching to surgical treatment. After the shock wave treatment of bile duct stones, we should take choleretic drugs such as Shu Chitong, Lichuanol or traditional Chinese medicine so that the stones can be discharged. And regularly do ultrasound review, if necessary, do cholangiography examination, in order to know the disappearance of stones.
Since 1988, 703 cases of gallstones have been treated with EDAP extracorporeal shock wave lithotripter in the surgery department of Zhongshan Hospital, Shanghai Medical University, and no damage has been found to the heart, lungs, liver, kidneys, pancreas, and gastrointestinal tract, and as long as there is no serious heart, lung, liver, or kidney disease, the treatment with shock wave is generally acceptable.
Milk can prevent gallstones
Drink a glass of whole milk before going to bed, can prevent gallstones. This is because milk stimulates the gallbladder and causes it to empty. In this way, the bile in the gallbladder is not easy to be retained and concentrated, and it is difficult to form stones.
What are the types of bile duct stones?
When you walk into the stone "kingdom", you will be amazed by the colorful and different shapes of gallstones. The color, some white as jade, some black like ink, and more dark yellow, brown or purple-brown; the shape, some round as a pearl, some with the shape of a pigeon's egg, there are triangular, multi-faceted, club-shaped, and so on; its hardness, some as hard as a rock, some soft like rice flour, when you use a knife to cut the stone, you can see that there are a kernel as the center, radial structure, some are like the trees, like the wheel of the year, a layered structure. When you cut the stones with a knife, you can see that some of them are centered on the core and have a radial structure, while others are like the annual rings of trees and have a laminar structure, and some of them are chaotic; some of them stand alone and dominate, while others coexist side by side and don't bother each other; some of them have similar sizes and shapes, and some of them are different in sizes. When these various forms of stones are in your eyes, you can not help but ask: why the same occurs in the biliary system of the stone, but there is such a colorful state? Medical scientists have shown that this is closely related to the cause, composition and location of the stones. Medical doctors have classified gallstones from different perspectives:
(1) According to the ingredients contained in the gallstones can be divided into three categories:
① cholesterol stones: due to excessive cholesterol contained in the bile, the dissolution of the gradual deposition of the cholesterol can not be removed. The majority of single-occurring, hard, round or oval, stones containing about 98% cholesterol, the appearance of light yellow or gray-yellow, smooth surface, the luster is very nice, the cut surface has a radial line. There are also multiple stones that are multifaceted or granular, which are not visible on X-ray flat film.
②Bile pigment stones, is the most common type of stone in China. Variable shape, soft and friable, no core or layered section, called " Oriental type stones ". Stones are composed of bile pigment, calcium salts, bacteria, and worm eggs. The size of the stones varies, the small ones are like mud and sand, the big ones are the size of soybean, the appearance is black or brownish red, the number is more, the volume is small, often with the discharge of bile flow, become the common bile duct stones.
3 mixed stones: whether it is bile pigment stones or cholesterol stones, in the stone formation, and can be outside the original stone, and then cholesterol or bile pigment, calcium salt deposits, thus forming a mixed bile pigment cholesterol gallstones. Due to the different proportions of the constituents, can show a variety of colors and shapes, generally seen for the spherical or multifaceted, the color of gray, yellow, brown, yellow-green, black, the section for the laminated, the layers of different shades, X-ray film can often be seen.
China's gallstones, according to reports from all over the world, mixed stones are the most common, followed by bile pigment stones and cholesterol stones are the least common. Because gallstones can block a variety of different sites, the symptoms that cause gallstone disease vary. This has a lot to do with the size and location of the gallstones, and the presence or absence of inflammation.
(2) According to the location of the stones can be divided into gallbladder stones, common bile duct stones and intrahepatic bile duct stones:
① gallbladder stones: mostly cholesterol and mixed stones. Gallstones in the gallbladder, usually does not cause jaundice, and does not produce colic ( unless stuck in the gallbladder duct ). Patients usually have occasional fullness and stuffiness in the upper middle or right abdomen, and sometimes have symptoms of indigestion such as belching, belching of acid, and abdominal distension. Symptoms can worsen after eating greasy food. There are also some patients who can be symptom-free for life.
②Total bile duct stones: most common in bilirubin stones. Gallstones can originate from the common bile duct, or from the gallbladder or intrahepatic bile duct. When gallstones are stuck in the common bile duct, the patient experiences pain, often with jaundice, chills, fever, gray stools, and deepened urine like strong tea. When this is coupled with inflammation of the common bile duct, it can lead to severe signs such as high fever and coma. When the gallstone moves out of position or is discharged from the bile duct into the duodenum, the patient's jaundice and inflammatory symptoms tend to subside.
3) Intrahepatic bile duct stones: mostly bilirubin stones. Intrahepatic bile duct stones account for about 15% of cholelithiasis. Because gallstones are small, sediment-like, and flow downward easily, most have common bile duct stones at the same time. Patients often have a history of recurrent abdominal pain, chills, fever, and jaundice from early childhood. This is because the gallstones block the flow of bile, which cannot be discharged and then turns into the bloodstream, where the patient's eyes and skin will turn yellow. Doctors call this phenomenon "obstructive jaundice". Also because the bile duct is blocked, for a long time, the nasty bacteria will take the opportunity to multiply in the bile duct to produce toxins, causing cholangitis. Can further invade the whole body, causing poisoning, shock, blood pressure drop, rapid pulse, apathy, white blood cells more than 20.0 × 109 / L, body temperature of 39 ℃ or more, the medical profession called this phenomenon "severe cholangitis". Other upstream infections can cause intrahepatic pyogenic cholangitis, liver abscess and so on.
Did gallstones exist in ancient times?
Biliary stone disease is probably as old as mankind, and gallbladder stones have been found in Egyptian mummies (1085-945 BC). However, it does not appear to be that common in terms of its incidence. It is thought that there were clinical descriptions of gallstone disease before the 4th century BC. In China, the autopsy of a woman's body in the Mawangdui tomb of the Western Han Dynasty revealed cholesterol and bile pigment stones in the gallbladder. The Chinese medicine has a long history of clinical description of biliary tract disorders.
How much does the world's largest gallstone weigh?
The same gallstones, in different patients, the number is not the same, fewer only 1 to 2, more than a few thousand, bulging bag. The small ones are like sesame seeds, the big ones are like eggs and can even be as big as a bucket.
December 29, 1952, London, England, Charing Cross Hospital for an eighty-year-old woman to take out one of the world's largest gallstones so far, as much as 6.29kg.
China's Navy Hospital Surgical Department, September 26, 1981, in the 55-year-old male patient in the common bile duct, take out the stone 215g.
Biliary stones occur in the gallbladder?
No. In addition to gallstones that can occur in the gallbladder, stones can occur wherever bile flows in the biliary system, such as the extrahepatic and intrahepatic portions of the biliary tract. The intrahepatic portion includes the left and right hepatic ducts and the branches of the hepatic bile ducts that are densely packed within the liver lobes; the extrahepatic portion includes the common hepatic duct, gallbladder, jugular duct of the gallbladder, common bile duct, and jugular area. Stones can arise in situ or come from the bile ducts above and flow down with the bile.
Why do people develop gallstone disease?
Gallstone disease is a disease in which certain components of bile (bile pigments, cholesterol, mucus substances, calcium, etc.) in the bile ducts precipitate and coagulate under the influence of various factors, resulting in the formation of stones. Stones can occur anywhere in the bile duct. However, most people do not develop gallstone disease because certain conditions are necessary for gallstones to form in the bile duct. The occurrence of gallstones is related to diet, infection, bile stagnation and other factors.
So what factors may promote the occurrence of gallstone disease in daily life?
So what factors may promote the occurrence of gallstones in daily life? ①The long-term intake of high-sugar, high-fat diets can cause the proportion of the three lipids in bile (cholesterol, lecithin, bile acids) to be out of proportion, and cholesterol is oversaturated and causes cholesterol stones. Contrary to cholesterol stones, bile pigment stones are likely to occur in people who habitually follow a low-protein, coarse-carbohydrate diet. The incidence of bilirubin stones is high in rural, coastal areas with relatively poor sanitation. Bile cultures grow with Escherichia coli, which produces enzymes during reproduction that exceed the inhibitory effect of glucuronic acid-1,4-lactone present in bile; hydrolyzing bound bilirubin and forming bilirubin stones. The formation of gallstones is a chronic and complex process, reasonable dietary structure and good hygiene habits can prevent the occurrence of this disease.
Why are there stones in the gallbladder?
While cholelithiasis is an ancient disease that has been studied for thousands of years, medical doctors have not been able to pinpoint the direct cause of gallstones until now. Currently experts believe that there are roughly the following factors:
(1) bile in the main components of the proportion of imbalance: bile in the composition of the above has been said, in addition to water, the solid component of bile salts, cholesterol, lecithin and other three major chemical components, mixed together in a viscous state. As we all know, water and oil are incompatible. Cholesterol is a lipid substance, and it becomes insoluble in water as well. The reason why cholesterol in normal people can be dissolved in bile relatively stably is mainly because there are enough bile salts and lecithin in the bile to form a gelatinous particle. If there is an increase in cholesterol in the bile, or a decrease in bile salts and lecithin, and the ratio between them is out of proportion, there is an excess of cholesterol, and cholesterol crystals are formed. And because they clump together with each other, more and more of them gather, so that, gradually, stones are formed. In addition, if the calories (calories) in the diet are too high, and the proportion of sugar is too high, it will also inhibit the liver from secreting bile salts, and the cholesterol will not be able to dissolve. Another example is in the diet of cholesterol (liver, eggs, meat, etc.) content, the secretion of cholesterol in the bile increased by 2 to 3 times, so that cholesterol in the bile is "oversaturated" state. This type of bile is called "cholelithogenic bile". These stones are called cholesterol stones.
(2) biliary roundworm disease: Japanese scholars on the surgical removal of calcium bilirubinate stones for research, found that 55% of the stones within the roundworm eggs. A hospital in Qingdao, China, 413 cases of gallstone dissection, found to roundworm residue as the core and the formation of stones accounted for 70% to 84%, Huzhou Second Hospital, a nurse, had taken out the gallstone 10 grains of surgery, sawed into two halves, found that the stone in the roundworm residue of 5 grains, observed under the microscope, found that there is a mass of roundworm eggs and ascaris lumbricoides angular skin of 3 grains, the above illustrates that ascaris lumbricoides is the formation of one of the important factors in the gallstones.
The roundworm is parasitized in the small intestine, where there are many kinds of bacteria, most commonly E. coli. Therefore, the bacteria adhering to the body of roundworms are also the most abundant in E. coli. Roundworms have a special habit of drilling holes wherever they can find them. There is a place in the duodenum called the duodenal papilla, which is a very small hole, the place is the roundworm from the intestines into the bile duct must pass through. The roundworms with sharp heads often desperately burrow into the bile duct. After drilling into the bile duct, some roundworms lay eggs in large numbers, and some die quickly, rotting and turning black, turning into segments of remains. Remnants and eggs of these foreign bodies, some by the bile duct movement and the role of the flow of bile, naturally discharged into the intestinal tract; some block the bile duct, stay in the bile duct, gradually formed into the core of the stone. At this time with the roundworm into the Escherichia coli, the bile duct as a hotbed of activity, take the opportunity to multiply, causing inflammation of the bile duct, edema, so that the secretion increases, cohesion, and play a role in the formation of the network of stones. And because E. coli can release an enzyme, have come out to make trouble, east and west, the original combination of bilirubin in the bile greatly destroyed, into free bilirubin. Free bilirubin and bile calcium combination, the formation of tiny particles downward precipitation. During the precipitation process, the tiny particles clump together and sludge through the web of glycoproteins, wrapping around a core of foreign matter. Layer after layer, layer after layer, like a snowball getting bigger and bigger, gallstones are formed in this way, this is a mixed stone. In the operating room, the physician in the process of opening, from the patient's bile duct sometimes removed the stone, roundworms and half exposed? Example:
Shao Moumou, after surgery, in the common bile duct to take out an egg-shaped mixed stone, the head of the roundworm half, the stone size of 2.5cm × 1.6cm × 2cm, weighing 31g.
Some people have done such an interesting experiment, will be a very thin thread into the rabbit's gallbladder, after a few months, a thin thread into a round stone.
(3) female hormones: estrogen can directly affect the liver's enzyme system, so that the bile secreted by liver cells containing bile acid salts to reduce the cholesterol secretion, but also interfere with the contraction function of the gallbladder, resulting in bile discharge obstruction, bile siltation, contributing to the occurrence of gallstones.
(4) obesity and physical activity is too little: obese people in the body cholesterol conversion rate is higher than normal, so that the bile cholesterol excretion increased easy to precipitate, the formation of stones. Do not like sports, sedentary habits, obesity, abdominal wall flaccidity, skinny people's liver prolapse, dietary long-term lack of fat, gallbladder muscle tone, can make the bile chronic siltation and the formation of stones.
(5) mental state: long-term mental tension, depression will make the visceral vegetative nerve disorders, affecting the gallbladder function, resulting in bile stasis. Because mental unhappiness will lead to a reduction in disease-resistant white blood cells, thus destroying the function of the body's immune system. Experts have observed a group of men who lost their wives, and in the first 14 months, their white blood cell count decreased significantly.
(6) Heredity: It has been confirmed that the incidence of cholelithiasis in the next generation is higher than in the general population, and some of these hereditary people are mainly due to the congenital low bile bile bile bile acid salt content, so that the cholesterol is very easy to oversaturation and not easy to dissolve, precipitation of the formation of stones.
What are the components in gallstones?
Cholestones are one of the most common diseases that threaten human health, but how exactly gallstones are formed remains a mystery. Currently, many scientists are working on gallstone research in an attempt to understand the causes and exact process of gallstone formation, and as a result, to find effective ways to prevent and treat gallstone disease. The first step in studying the causes of gallstone disease is to find out what gallstones are made of. Advances in modern analytical chemistry have provided powerful technical means for studying gallstone composition. Through the application of various modern technological methods such as quantitative chemical microanalysis, infrared spectroscopy, atomic emission and atomic absorption spectroscopy, electron microprobe, as well as proton-excited X-ray emission analysis, it has been found that the chemical composition of gallstones is very complex, including cholesterol, calcium bilirubinate, calcium carbonate, calcium phosphate, phospholipids, proteins, and a variety of metallic elements such as copper, iron, manganese, zinc, lead, strontium, titanium, chromium, and nickel, and that every patient has gallstones that do not have exactly the same composition. Despite this complexity, scientists have found that some stones contain more than half of the stone's weight in cholesterol, while others have calcium bilirubinate and its derivatives as their main component. As a result, these two types of stones were referred to as cholesterol stones and bilirubin stones, respectively. The analysis of the composition of gallstones provides a very important insight into the causes of gallstones. We know that cholesterol and bilirubin are the two main components of bile, so the next people set out to explore the original cholesterol and bilirubin have been dissolved in the bile, under what circumstances, through what process before precipitation precipitation, and then the formation of stones.
Why are bile pigment stones common in China and cholesterol stones common in Western countries?
Primary bile duct pigment stones account for about 50% of gallstone cases in China. Diseases closely related to bile pigment stones are also known as Chinese bile duct obstruction syndrome. This is related to the dietary structure and living environment of our people. The diet of Chinese people is mainly composed of carbohydrates to a balance of proteins, fats and carbohydrates; coupled with the lifestyle of the vast rural and coastal areas, roundworms are quite widespread in the body, and roundworms can bring bacteria into the biliary tract. Bacteria can also be discharged into the biliary tract via portal blood flow to the liver, and intestinal bacteria can also be returned to the biliary tract through the sphincter of Oddi's; biliary tract infections occur in almost all patients with intrahepatic bile duct stones, the density of bacteria in the bile is very high, and recurrent biliary infections reduce the resistance to injury of biliary tissues, resulting in poor regeneration of biliary epithelium, increasing the incidence of biliary strictures, and resulting in biliary stagnation. Bile stagnation is conducive to the propagation of bacteria in the bile and the production of large amounts of β-glucuronidase, both of which are important causes of the formation of pigment stones in the bile ducts.
In Western countries, on the other hand, stones are cholesterol-based, and their diets are structured around refined carbohydrates. In Japan, two-thirds of gallstones were originally bile pigment stones, but in recent years the incidence of these stones has decreased significantly with the westernization of the diet, while cholesterol stones have increased significantly.In 1984, we analyzed the gallstones in the Beijing area, and found that the changes in the types of gallstones were similar to those in Japan, and that this trend was related to the decrease in the rate of Ascaris lumbricoides infection among the urban population in China, and the increase in the content of dietary proteins and fats. Gallstone disease is rare among blacks in Africa, and Capron attributed this to the rich fiber content of the black diet. However, among blacks with a westernized diet and a higher standard of living, there is an increased incidence of cholesterol stones. So diet and lifestyle habits are positively correlated with the type of gallstones.
Who is at risk for gallstones?
Although gallstone disease is common, not everyone develops gallstones. So, who is prone to gallstone disease? Through clinical observation, experimental research and epidemiological surveys, scientists have identified many "risk factors" for gallstone disease. People with these "risk factors" are prone to gallstones. The "risk factors" for cholesterol stones include:
(1) Older age The incidence of gallstones in teenagers is very low. The incidence of gallstones increases gradually with age, so middle-aged and older people are more likely to develop gallstones than young people, and the older they are, the more they develop gallstones.
(2) Women Women are more likely to develop cholesterol stones than men, and female patients are generally more than twice as likely as male patients. Women with multiple pregnancies are more likely to develop gallstones, and women who have been taking oral contraceptives for a long time or who have been treated with estrogenic drugs after menopause are also more likely to develop cholelithiasis.
(3) Obesity Obese people are prone to gallstone disease. Obese people have long-term over-nutrition, bile contains a higher amount of cholesterol, which can lead to the formation of cholesterol stones.
(4) Diet People who eat more often and whose food contains high amounts of animal fats, cholesterol and sugar are prone to cholesterol stones. The western style of diet is a major factor in the formation of cholesterol stones.
(5) Certain diseases Patients suffering from restrictive ileitis are prone to cholesterol stones, which is due to the fact that the diseased ileum is unable to fully absorb the bile acids in the intestines, resulting in an excessive loss of bile acids. By the same token, patients who have undergone ileal resection are also prone to cholesterol stones.
Anyone with the above "risk factors" should always be alert to the occurrence of gallstones, such as a middle-aged obese women, after meals often feel full of epigastric boredom, or even distension discomfort, should go to the hospital in a timely manner to check to determine whether the gallstones. Usually avoid eating too much and excessive obesity, to prevent gallstones also have a certain role.
What are the top 10 triggers for gallstones?
According to scientists, gallstones have the following ten predisposing factors:
(1) Often preferring a diet high in sugar, cholesterol and fat.
(2) Those who suffer from biliary parasitic diseases, such as roundworm and liver flukes.
(3) Those with increased female hormones.
(4) Those who are obese and have reduced physical activity.
(5) Those with gallbladder and biliary tract infections.
(6) Those who suffer from certain diseases, such as diabetes, nephritis, hypothyroidism, hemolytic disease, and so on.
(7) Long-term use of lipid-lowering drugs: such as Antomin, niacin.
(8) Emotions: long-term mental tension, depression.
(9)Heredity.
(10) Surgery: such as vagotomy, which disrupts the emptying function of the gallbladder; extensive resection of the distal small intestine, which causes obstruction of hepatic-intestinal circulation of bile salts.
Why can gallstones cause biliary bleeding?
Biliary bleeding due to gallstones is often associated with a combination of infection on top of gallstones. There are three types of pathogenesis: ① intrahepatic diffuse small cholangitis, pericholangitis type. The main lesions in the confluence area, the interregional lobular ducts and interlobular veins communicate with the occurrence of multiple small bile duct vascular fistulae, a wide range of small bile duct hemorrhage convergence into biliary hemorrhage. ② Liver abscess type. Multiple hepatic abscesses of biliary origin converge into a large abscess, and the pus corrodes the branches of the hepatic artery or portal vein, leading to biliary hemorrhage. (iii) Hepatobiliary ulcer type. In acute obstructive purulent cholangitis, the mucosal epithelium of the hepatic bile duct above the obstruction is detached to form multiple ulcers, and the ulcers can penetrate the adjacent hepatic artery and portal vein and cause biliary hemorrhage.
Is magnetic **** vibration examination valuable in the diagnosis of gallstones?
Magnetic *** image on the T?2 weighted image, the gallbladder is a high signal area, in which the stones are low signal shadow, but small stones are often covered by high signal bile and not easy to show the appearance. It is generally believed that the effect of nuclear magnetic **** vibration check gallstones is far less than ultrasound, and compared with CT is also inferior. Therefore, gallstones are not an indication for NMR***Vibration, and should not be used as the preferred method of examination.
How effective is the surgical treatment of gallstones?
Although there are many non-surgical methods to treat gallstones, such as extracorporeal shockwave lithotripsy, oral lithotripsy, injection of methyl tert-butyl ether to directly dissolve cholesterol stones, application of traditional Chinese medicine, etc., some of these methods are still in the stage of clinical research, and some of them are not accurate and unsatisfactory, and most of the methods are only applicable to some of the patients with gallstones. Therefore, surgery is still the main means of stone treatment. After surgical treatment of gallstones, the majority of patients will achieve more satisfactory results, the patient's symptoms will be relieved, can completely restore health, and live a life as normal. However, a small number of patients will still have symptoms of gallstones after surgery, and the gallstones will recur, even requiring surgery again.
What should I do if I find gallstones in my bile ducts after a T-tube cholangiogram?
There are cases where the bile ducts were carefully explored during the surgery and it was thought that the gallstones had been taken out, but after the surgery, a T-tube cholangiogram was performed and it was found that there were still some gallstones in the bile ducts, and the patient often complained that the doctor had not been careful in the surgery. In fact, although the doctor's surgery is very careful and conscientious, and in the operation also made cholangiography or fiberoptic cholangioscopy for the examination, will always find that a few patients in the bile duct of the stones are not taken out. If a stone is found to remain, some of the following measures can be taken:
(1) Wait for the stone to be discharged on its own
The stone is small, and sometimes, although it is not specially treated, it will be discharged into the duodenum through the sphincter of Oddi's. The patient's cholangiogram is a very careful and careful procedure, and it is always found that a few patients do not have all the stones in their bile ducts.
(2)Saline irrigation
Saline water is injected at a certain pressure from a "T" shaped tube to flush the bile ducts, which sometimes flushes the stones from the bile ducts into the duodenum.
(3)Removal of stones by fiberoptic cholangioscopy
If the "T" tube is thicker, it can be removed in the sixth week after the operation, and the fiberoptic cholangioscopy can be passed through the original "T" tube. "The fiberoptic choledochoscope is then placed into the common bile duct through the fistula of the original T-tube, and the stone is removed by placing a stone catheterizing mesh into the duct.
(4)Endoscopic papillary sphincterotomy
This method is to use a fiberoptic duodenoscope to check the opening of the common bile duct in the duodenum, when the opening of the common bile duct in the duodenum is seen to be papillate, and then a special papillary sphincterotomy knife is sent into the bile duct through the fiberoptic duodenoscope, and then the papillary sphincter is cut off, which not only enlarges the opening of the common bile duct in the duodenum, but also makes it easy to drain the stones into the duodenum. stones to be easily drained into the duodenum.
(5)Stone dissolution
The injection of certain drugs, such as bile salts, heparin and methyl tertiary butyl ether, through the T-tube can sometimes dissolve the stones and expel them.
(6) Surgery
If none of the above methods are effective, then the stone can only be removed by another surgery.
Why are stones found after surgery?
Surgery is an effective treatment for gallstone disease. However, some patients, several years after surgery, the old disease recurred, the bile ducts or residual stones, or the emergence of new stones, this situation is called biliary tract residual stones, the patient who suffered from abdominal pain is often unprepared for this, very fearful, do not know what to do. Why do residual bile duct stones occur? This is the cholelithiasis patients are very concerned about. According to the 1983 national academic conference statistics, China's biliary tract residual stone incidence rate of 20% to 40%, much higher than abroad. There are several reasons:
(1) the cause of the disease itself:
1) in emergency surgery, due to the time rush, critical condition, poor general condition, should not be a long time surgery and stone removal is not complete.
②There are too many stones, especially in the intrahepatic bile ducts, which can not be removed at once or difficult to remove stones.
3) Some patients, after gallbladder removal, are prone to form new stones, called recurrent stones, due to the abnormal composition of the bile discharged from their liver (called lithogenic bile).
(2) Medical conditions: Due to the limitations of medical equipment or technology, it is not possible to make an accurate judgment on the location, size and number of stones, so that the stones are removed blindly and easily missed. It may also be due to the doctor's choice of inappropriate surgical methods, such as multiple gallbladder stones without first ligating the cystic duct, and the surgical operation of the squeeze so that part of the gallbladder within the gallbladder gallstones are squeezed into the common bile duct.
Why do some cholelithiasis patients need another or multiple surgeries?
The incidence of repeat or multiple surgeries for biliary diseases is the highest of any other disease in the body. Why is this so? It is mainly due to the following factors:
(1) Sometimes the patient's condition is so severe that he or she cannot tolerate radical, larger surgeries and only emergency measures can be taken. First do cholecystostomy or choledochotomy, T-tube drainage and decompression to save the patient's life. Wait for 3 months and then according to the specifics of the lesion, choose the appropriate surgical procedure to carry out the second stage of surgical treatment.
(2) Because of the anatomical variability of the biliary system, intraoperative bile duct injuries of medical origin can easily occur.
(3) Biliary tract disorders, due to their complexity and specificity, such as intrahepatic bile duct stones are often not easy to remove, bile duct stones are prone to recurrence, and other factors, leading to the possibility of biliary reoperation.
(4) The situation of the whole biliary system, especially the intrahepatic lesions, is not fully clarified before and during the operation, and thus the lesions are missed and not properly treated.
(5) Omission of intra-biliary stones or sphincter stenosis lesions during surgery for gallbladder stones.
(6) Development of chronic cholangitis after surgery, which can lead to secondary strictures and bile duct? /td>