Cholesterosis gallbladder - is pathological changes obmennodistroficheskogo type symptoms which are caused by excessive deposition of cholesterol layers on the surface of the inner wall of the gallbladder.Cholesterosis gallbladder develops any age period, but the main risk group patients are middle-aged, obese.Despite the development of technologies in the field of diagnostic medical specialties, this pathological condition is rarely established in the routine examination of the patient, however, according to the autopsy and histological analysis of the gallbladder after cholecystectomy in 50% of cases cholesterosis gallbladder wall.
Causes gallbladder cholesterosis
Accurate cause of gallbladder cholesterosis not installed, but it is clear that this pathology is a consequence of lipid metabolism.Thus, any disease, with an imbalance in the synthesis and breakdown of lipids in the body, will inevitably provoke the signs of gallbladder cholesterosis.
To predispose cholesterosis include endocrine thyroid disease with concomitant hypothyroidism steatosis accompanied by excessive accumulation in the liver tissue products of fat metabolism, the large number of cholesterol stones in the gallbladder lumen.
Recent randomized studies in the field of gastroenterology and surgery, proved correlation dependence cholesterosis appearance and availability of patient symptoms syndrome enhanced bacterial proliferation in the lumen of the intestine under the influence of applied antibacterial drugs and severe disorders of immunity.
Persons with symptoms such as abdominal obesity prone to develop cholesterosis, since this disease is a total metabolic disorders with excess products of fat metabolism in all structures and tissues, including the gallbladder.
should not think that in the normal index lipidogram patient can not develop cholesterosis gall bladder, as in the pathogenesis of this disease is an increasingly significant role played by intracellular transport of cholesterol.Under normal conditions on the surface of the inner wall of the gallbladder is a small amount of unesterified cholesterol absorbed.A minority of cholesterol permeates serous layer of the gallbladder, and the rest goes back into the bile.Violation of removing excess cholesterol from the gallbladder can be provoked by a relaxing effect of progesterone on vascular walls, as well as the pathological changes of lymphatic vessels.Great influence on the transport of lipids has a status of evacuation function of the gallbladder, which can be weakened in violation plexus, which is located directly in the wall of the bladder.
Symptoms of gallbladder cholesterosis
clinical picture cholesterosis gallbladder is usually slow-progressive course and a long latency period, during which the patient did not notice any changes in their health status.This pathology is almost never established only on the basis of available clinical symptom, as cholesterosis gallbladder has no specific symptoms, distinguishing it from other disorders of the gastrointestinal tract.
Patients with gallbladder cholesterosis complain of frequent episodes of pain localized in the right upper quadrant of the projection of the abdomen, which is triggered by the appearance of eating disorders.The emergence of pain localization in the evening hours allows the specialist to suspect the presence of the patient's metabolic and degenerative diseases of the gallbladder.
for this category of patients is very common symptoms related to the category of dyspeptic disorders (nausea, which has a clear link with a fatty meal, the heartburn in the morning, disorders of the intestine in the form of alternating episodes of diarrhea and constipation).All these symptoms are ongoing and have moderate severity, so the patient rarely seeks medical help.
In a situation where cholesterosis gallbladder complicated inflammatory changes and the formation of cholesterol stones, there is a significant deterioration of the patient's condition and the appearance of symptoms typical of biliary colic.The debut episode calculous cholecystitis is the appearance of a sharp dagger abdominal pain with no clear localization and accompanied by radiating to the surrounding anatomical area, multiple gagging, the implementation of which is not complete relief of the patient, sudden loose stools frequent episodes of diarrhea and fever forHectic type with accompanying signs of intoxication syndrome.
In a situation where cholesterosis gallbladder is not accompanied by the formation of stones, the patient long period of time there are no clinical manifestations, and at calculous Cholesterosis the fore signs of evacuation function of the gallbladder.Special morphological form of this disease is considered "polipovidny cholesterosis", which is considered to be the lot of detection experts diagnostic profile, however, with a significant increase in the size of polyps develop stormy clinical symptoms characteristic of diseases of the biliary tract.
Treatment gallbladder cholesterosis
long period of time cholesterosis gallbladder was considered an absolute indication for cholecystectomy, but is now accurate imaging tools allow more detailed study of the safety function of the gallbladder and the possibility of postponing the surgery.
should not resort to medication cholesterosis immediately after diagnosis by ultrasound or CT scan.Most gastroenterologists are committed to delaying tactics, backed the recommendations for the correction of eating behavior and follow-up of changes in the gallbladder using ray imaging techniques.However, instrumental confirmation of the presence of the patient polipovidnoy cholesterosis form is an indication for the use of the active drug therapy, regardless of the number and size of polyps existing wall surface.
Note that the decrease in the number of polyps during the ultrasound examination in dynamics is not an indication to stop the treatment, as these tumors tend to samoamputatsii even in the absence of remedial measures.In a situation where the entire inner wall of the bladder is covered with polyps, it is recommended carrying out surgical treatment, as for Ehostruktura multiple adenomatous polyps can hide the defeat of the gallbladder wall, inaccessible to visualization.
When deciding whether to use conservative treatment for a particular patient should be a priority evaluation of contractile function of the gallbladder, and in situations where the coefficient of discharge does not reach 30%, do not expect positive results from drug therapy.
All used in the treatment of gallbladder cholesterosis drugs are aimed at alleviating the patient's condition by symptomatic therapy, stop the progression of pathological processes in the gallbladder, lipid profile correction and prevention of possible complications.
Preparations are considered symptomatic of a number of medications that eliminate symptoms of functional dyspepsia (Motillium, Metospazmil at a daily dosage of 300 mg orally).The action of these drugs is aimed at improving motor evacuation function of the upper digestive tract, and therefore, the majority of patients with cholesterosis in the first day of the drug say the elimination of nausea, heartburn, flatulence.
presence of severe pain syndrome in patients with biliary colic is an indication for the use of parenteral antispasmodic (Riabal 2 ml intramuscular with subsequent transition to intake the tablet form of the drug), whose action is directed to smooth muscle relaxation.
In order to prevent the development of stones in the gallbladder lumen in all patients suffering from cholesterosis, it is recommended to take long-term preparations of bile acids (Ursohol a daily dose of 15 mg per 1 kg of body weight).According to the randomized study, drugs of this pharmacological group contribute samoamputatsii and the subsequent dissolution of wall polyps of small size.
Due to the fact that in the pathogenesis of gallbladder cholesterosis great importance is the so-called "sludge syndrome", pathogenetically justified in this situation is the appointment of a patient hepatoprotector Gepabene 1 capsule three times a day, which has not only cholereticeffect, but also enhances the contractile function of the biliary tract.
Recently, a smaller percentage of gallbladder cholesterosis subjected to surgical treatment and is associated with improved diagnostic measures, but there are undeniable absolute indications for cholecystectomy, which include:
- impossibility of differentiation cholesterosis and neoplastic processes in the wall of the gallbladder;
- the lack of positive results from the use of medication and negative ehoskopicheskaya dynamics;
- contractility of the gall bladder at less than 30%;
- the presence of multiple stones;
- frequent aggravation cholecystitis.
Diet for Cholesterosis
Despite the rapid development of the pharmaceutical industry, which produces a huge amount of drugs, to successfully eliminate symptoms cholesterosis gallbladder, representatives of the World Association of gastroenterologists insist on the need to use non-drug therapy for conservative these patients.
basis of conservative treatment cholesterosis make dietary recommendations, advice on the restructuring of the culture of eating behavior, helps to normalize the patient's weight and improve metabolic transformations in the body.
Cholesterosis gallbladder is seen by many experts as a background condition for the further development and cholecystolithiasis calculous cholecystitis, so the use of a diet can be considered preventative measure.
In drawing up the daily diet for a patient diagnosed with cholesterosis should be guided by the following recommendations:
- food should be reusable and cover the needs of man in all vital elements;
- when choosing meat products should be preferred coarse fiber low-fat varieties (duck, goose, chicken, beef);
- unlimited use of products of dairy origin and vegetables;
- refusal of the use of even small doses of liquor.
Besides continuing compliance with the principles of diet, the patient is recommended to enhance physical activity, during which further intensifies the breakdown of fats and excretion of their metabolites from the body.