Gallstones refer to stones formed in the biliary system (including the gallbladder and bile duct), also known as cholelithiasis, which is a common disease of the digestive system. The occurrence of this disease is mainly affected by environmental factors, genetic factors and the patient's personal lifestyle. Under normal circumstances, the human liver secretes bile to promote the digestion of fats and other substances. However, if long-term unhealthy living and eating habits, such as irregular meals, skipping breakfast, obesity, etc., may cause bile secretion disorders and changes in bile components Wait for the situation. Crystals are precipitated in the bile, and the crystals gradually become calcified, forming stones.
According to the location of the stone, gallstones can be divided into gallbladder stones and bile duct stones.
Small gallbladder stones are prone to incarceration
Gallbladder stones can be subdivided into asymptomatic gallbladder stones and symptomatic gallbladder stones. Most patients are asymptomatic and are usually found during physical examination. If the gallbladder stones are large, it may cause symptoms such as upper abdomen or upper right abdomen swelling and discomfort; patients with smaller stones usually eat greasy food, after a full meal, or during sleep due to changes in body position, which may cause the movement of the stones to become stuck in the stenosis Locations, such as the neck of the gallbladder, appear incarcerated, causing acute obstruction of the cystic duct. As a result, the excretion of bile is blocked and cannot be discharged from the gallbladder, which may increase the internal pressure of the gallbladder. When the internal pressure of the gallbladder is gradually increased, the strong contraction of the gallbladder will cause the patient to have biliary colic, which is manifested as severe right upper abdominal pain, which is painful, which can radiate to the right back or shoulder. Each pain can last for 15-30 minutes. . Some patients have a dull pain in the upper abdomen, sometimes accompanied by fullness, discomfort, acid reflux, nausea, belching and other symptoms. They often appear when overeating, eating greasy food, excessive stress, and poor rest, and they are easy to be mistaken. It is considered to be a stomach problem and needs to be paid more attention.
In addition, gallbladder stones may also have jaundice, and the general symptoms are mild; stones incarcerated in the ampulla through the common bile duct may cause pancreatitis; when combined with gallstone intestinal obstruction, gallbladder cancer, etc., there are corresponding symptoms.
The symptoms of bile duct stones depend on whether there is a biliary tract infection
Bile duct infection and cholestasis are the basic conditions for the formation of bile duct stones. After a biliary tract infection occurs, the bacteria in the bile will secrete glucuronidase, mucus, and phospholipase A1, which will make the calcium bilirubin supersaturate and precipitate, and then form stones. At the same time, cholestasis accelerates the formation of bile duct stones. In addition, bile duct obstruction, bile duct stenosis, segmental expansion of the bile duct, and the presence of foreign bodies in the bile duct such as ascaris remnants, malnutrition, etc., can all induce bile duct stones.
Bile duct stones are divided into extrahepatic bile duct stones and intrahepatic bile duct stones according to the location of the stones. In recent years, the overall incidence of intrahepatic bile duct stones has shown a downward trend. With the increase in the incidence of gallbladder stones in China, the incidence of extrahepatic bile duct stones triggered by gallstones falling into the bile duct has also increased significantly.
The symptoms of bile duct stones depend on whether there is a biliary infection. For example, when extrahepatic bile duct stones obstruct the bile duct and secondary infection, the typical Charcot triad will appear, namely abdominal pain, chills, high fever, and jaundice. Sexual seizures or persistent pain with paroxysmal aggravation can radiate to the right shoulder and back; about 2/3 of patients can have chills and high fever, and the body temperature can be as high as 39-40 ℃; The color of urine becomes darker, and the color of stool becomes lighter. When the bile duct is completely obstructed, it will be clay-like, and the patient may have skin itching.
According to the progress and severity of the disease, the clinical manifestations of intrahepatic bile duct stones can be divided into static type, obstructive type, cholangitis type, and sclerosing type: static type patients have no obvious symptoms or mild symptoms, only upper abdominal pain and discomfort, usually during physical examination Only discovered; obstructive manifestations include persistent dull pain and discomfort in the liver area, chest and abdomen, intermittent jaundice, and decreased digestive function. If bilateral bile duct stones are accompanied by hepatobiliary stenosis, it can be manifested as persistent jaundice; cholangitis-type manifestations Recurrent acute purulent cholangitis, epigastric colic or persistent pain, chills, fever, jaundice, etc. may occur during the acute attack; the sclerosing type may have hepatosplenomegaly and persistent and worsening jaundice , Ascites, gastrointestinal bleeding, etc.
In addition to the difference in symptoms, there are also differences in the treatment of gallbladder stones and bile duct stones: asymptomatic isolated intrahepatic bile duct stones can be considered for regular close follow-up observation, and those with repeated clinical symptoms should consider surgery, removing the stones and removing the lesions; extrahepatic bile duct stones Surgical treatment is the main treatment, removing stones to relieve biliary obstruction; gallbladder stones can be treated with drugs, and surgical removal of the gallbladder is only considered when there are surgical indications.
