Cholesterol of the gallbladder
Cholestasis of the gallbladder is a pathological change of the obmenodistrophic type, the manifestations of which are caused by the excessive deposition of cholesteric layers on the surface of the inner wall of the gallbladder. Cholesterol gallbladder develops in any age, but the main risk group is middle-aged patients suffering from obesity . Despite the development of technology in the diagnostic field of medicine, this pathological condition is rarely established by routine examination of the patient, but according to autopsy and histological analysis of the gallbladder after cholecystectomy, cholesterosis of the gallbladder walls is observed in 50% of cases.
Causes of cholesterosis of the gallbladder
A reliable cause of gallbladder cholesterosis has not been established, but it is clear that this pathology is a consequence of a violation of lipid metabolism. Thus, any disease, accompanied by an imbalance in the processes of synthesis and disintegration of lipids in the body, inevitably provokes the appearance of signs of cholesterosis of the gallbladder.
Predisposing factors in the development of cholesterosis include: endocrine pathology of the thyroid gland with concomitant hypothyroidism , fatty hepatosis , accompanied by excessive accumulation in the hepatic tissue of fat metabolism products, the presence of a large number of cholesterol concrements in the gallbladder lumen.
The most recent randomized studies conducted in the field of gastroenterology and surgery proved the correlation dependence of the onset of cholesterosis and the presence of signs of a syndrome of enhanced bacterial proliferation in the lumen of the intestine under the influence of antibacterial drugs and severe immunity disorders.
Persons with signs of abdominal obesity are prone to developing cholesterosis, as this disease causes total metabolic disorders with excessive accumulation of fat metabolic products in all structures and tissues, including the gall bladder.
Do not think that with normal lipidogram, the patient can not develop gallbladder cholesterosis, since the intracellular transport of cholesterol plays a more significant role in the pathogenesis of this disease. Under normal conditions, a small amount of absorbed unesterified cholesterol is located on the surface of the inner wall of the gallbladder. A small part of the cholesterol permeates the serous layer of the gallbladder, and the rest of it comes back to the bile. Disruption of the process of removing excess cholesterol from the gallbladder can be provoked by the relaxing effect of progesterone on the vascular walls, as well as pathological changes in lymphatic vessels. The state of evacuation function of the gallbladder has a great influence on the transport of lipids, which can be weakened by the disturbance of the nerve plexus located directly in the wall of the bladder.
Symptoms of cholesterosis of the gallbladder
The clinical picture of gallbladder cholesterosis has, as a rule, a slow-progressive course and a long latent period, during which the patient completely does not notice any changes in the state of his own health. This pathology is almost never established only on the basis of the existing clinical symptom complex, since cholestasis of the gallbladder does not have specific manifestations that distinguish it from other pathologies of the organs of the gastrointestinal tract.
Patients with gallbladder cholesterosis complain of frequent episodes of pain syndrome localized in the projection of the right upper quadrant of the abdomen, the appearance of which is provoked by a violation of diet. Occurrence of pain of this localization in the evening allows the specialist to suspect the presence of the patient with metabolic dystrophic gallbladder disease.
For this category of patients, the appearance of symptoms related to the category of dyspeptic disorders (nausea, which has a clear connection with the intake of fatty foods, heartburn in the morning hours, disorders of the intestinal activity in the form of alternating episodes of diarrhea and constipation ) is very typical for this category of patients. All of the above symptoms are of a permanent nature and have a moderate degree of severity, so the patient rarely seeks medical help.
In a situation where gallbladder cholesterosis is complicated by inflammatory changes and the formation of cholesterol stones, there is a significant deterioration in the patient's condition and the appearance of signs of typical biliary colic. The debut of an attack of calculous cholecystitis consists in the appearance of acute daggerache in the abdomen, which has no clear localization and is accompanied by irradiation to nearby anatomical areas, repeated urge for vomiting, which does not end with relief of the patient's condition, a sharp loosening of the stool with frequent episodes of diarrhea and fever Hectic type with concomitant signs of intoxication syndrome.
In a situation where gallbladder cholesterosis is not accompanied by the formation of concretions, the patient has a long period of time, there are no pronounced clinical manifestations, and with calculous cholesterosis, the signs of disruption of the evacuation function of the gallbladder appear to the fore. A special morphological form of this pathology is "polypoid cholesterosis", the detection of which is considered to be the lot of specialists in the diagnostic profile, but with a significant increase in the size of polyps, the rapid clinical symptoms characteristic of diseases of the biliary tract develop.
Treatment of gallbladder cholesterosis
For a long period of time cholesterosis of the gallbladder was considered an absolute indication for the use of cholecystectomy, but at the present time accurate instrumental imaging methods allow more detailed study of the preservation of gallbladder function and the possibility of postponing surgical treatment.
Do not resort to drug treatment for cholesterosis immediately after diagnosis by ultrasound or computed tomography. Most gastroenterologists are adherents of expectant management, supported by recommendations for correcting eating behavior and dynamic monitoring of gallbladder changes with the help of beam imaging techniques. However, the instrumentally confirmed presence of a polypoid form of cholesterosis in a patient is an indication for the use of active drug therapy, regardless of the number and size of the available parietal polyps.
It should be borne in mind that a decrease in the number of polyps during the ultrasound examination in dynamics is not an indication for discontinuing treatment, as these tumors tend to self-amputation even in the absence of therapeutic measures. In a situation where the entire inner wall of the bladder is covered with polyps, surgical treatment is recommended, since the echostructure of multiple polyps may conceal an adenomatous gallbladder lesion that is not visible to the visualization.
When deciding on the advisability of conservative treatment in a patient, priority should be given to assessing the contractile function of the gallbladder, and in a situation where the emptying rate does not reach 30%, do not expect positive results from drug therapy.
All medicines used in the treatment of gallbladder cholesterosis are aimed at alleviating the patient's condition by symptomatic therapy, stopping the progression of pathological processes in the gallbladder, correcting the lipidogram and preventing possible complications.
Drugs of the symptomatic range are considered to be drugs that eliminate signs of functional dyspepsia (Motillium, Methaspazmil in a daily dosage of 300 mg orally). The effect of these drugs is aimed at improving the motor evacuation function of the upper part of the digestive tract, therefore, the majority of patients with cholesterosis already notice the elimination of nausea, heartburn, flatulence on the first day of the drug.
The presence of severe pain syndrome in patients with biliary colic is an indication for the use of parenteral antispasmodics (Riabal 2 ml intramuscularly with the subsequent transition to taking the tablet form of the drug), whose action is directed to the relaxation of smooth muscles.
In order to prevent the development of concrements in the lumen of the gallbladder, it is recommended that all patients suffering from cholesterosis take bile acid preparations for a long time (Ursohol in a daily dose of 15 mg per 1 kg of the body weight of the patient). According to randomized trials, the drugs of this pharmacological group promote self-amputation and subsequent dissolution of small-sized marginal polyps.
In connection with the fact that in the pathogenesis of the development of cholesterosis of the gallbladder, the so-called "sludge syndrome", which is pathogenetically grounded in this situation, is the appointment of a patient with hepatoprotector Gepabene 1 capsule three times a day, which not only has a choleretic effect, but also improves the contractile function of the biliary tract.
Recently, an ever-lower percentage of gallbladder cholesterosis is undergoing surgical treatment and this is associated with improved diagnostic capabilities, but there are undeniable absolute indications for cholecystectomy, which include:
- impossibility of differentiation of cholesterosis and neoplastic process in the wall of the gallbladder;
- the lack of positive results from the use of medication and negative echoscopic dynamics;
- contractility of the gallbladder at a level of less than 30%;
- presence of multiple concrements;
Frequent exacerbations of cholecystitis.
Despite the rapid development of the pharmacological industry, which produces a huge number of drugs that can successfully eliminate the signs of cholesterosis of the gallbladder, representatives of the world association of gastroenterologists insist on the need for non-drug conservative therapy for this category of patients.
The basis of conservative treatment of cholesterosis is dietary recommendations, advice on the restructuring of the culture of eating behavior, which allows to normalize the weight of the patient and improve metabolic transformations in the body.
Cholesterol of the gallbladder is considered by many specialists as a background disease for the further development of cholecystolithiasis and calculous cholecystitis, therefore the use of diet can be considered a preventive measure.
When preparing a daily ration for a patient with diagnosed cholesterosis, the following recommendations should be followed:
- food should be reusable and cover the human needs in all vital elements;
- when choosing meat products, preference should be given to coarse-fiber non-fatty varieties (duck, goose, chicken, veal);
- unlimited use of products of milk origin and vegetables;
- refusal to use even small doses of strong alcoholic beverages.
In addition to constant adherence to the principles of dietary nutrition, the patient is encouraged to increase physical activity, during which the additional splitting of fats and the removal of their metabolites from the body is intensified.