How to check the gallbladder and liver? Treatment of blockage of the bile ducts. Diagnosis and treatment of cholecystitis

According to statistics, gallbladder disease is diagnosed in 300 out of 100,000 people. Many patients complain of frequent nausea, a bitter taste in the mouth, and indigestion. If these problems occur, you should consult a doctor.

Many patients are interested in the question of how to check the gallbladder. The doctor will prescribe necessary research and establish a diagnosis. The main thing is to find a qualified specialist who will conduct a thorough diagnosis and provide accurate results.

Basic information

The gallbladder (GB) is a small pear-shaped organ that is located under the liver. The liver constantly produces bile, which enters the gallbladder and duodenum 12 through the bile ducts.

The gallbladder is located under the liver

With disorders of the functionality of the biliary system (ZHP and bile ducts), bile penetrates into the intestine or pancreas. Most often this occurs when the bile ducts are blocked by stones. But the liver secret can destroy any organs.

Normally, hepatocytes produce a brown or greenish liquid with a bitter taste, this is bile. After the penetration of food from the stomach into the intestines, the walls of the gallbladder contract, and secrete a secret through the biliary tract into the duodenum, where it breaks down some components of the liver.

Under influence negative factors inflammation of the gallbladder occurs. Diseases of the biliary tract organs provoke violations of the functionality of the liver, digestive disorders and general condition.

The main symptom of gallbladder disease is severe pain on the right under the ribs, which radiates to the stomach. In addition, the likelihood of bitterness in the mouth, after which a bitter aftertaste appears, increases. The patient suffers from indigestion and disturbance of the natural bacterial flora. Sometimes there are urination disorders or constipation.

Often during an attack, the skin and whites of the eyes turn yellow. This symptom disappears on its own after it ends. Therefore, if you experience nausea, discomfort or pain in the right side of the abdomen, action should be taken.

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Laboratory research

Patients with pathologies of the gallbladder are interested in the question of what tests will be performed. A laboratory blood test is an important step in the diagnosis of diseases of the biliary tract. During the procedure, specific markers of the liver and gallbladder are studied. The main marker studied is bilirubin (bile pigment), which accumulates in the urine and blood, provokes jaundice. After receiving the results, the doctor decides what studies will be carried out further to make a diagnosis.

With the help of laboratory tests, it is possible to identify the state of the organs of the biliary tract

Analyzes to detect diseases of the biliary system:

• Clinical blood test. This diagnostic method will allow you to identify changes occurring in the body. Thus, inflammation of the gallbladder can be detected. But to establish a diagnosis, it is worth conducting other tests.
• Biochemistry of blood. This study includes several tests that need to be done to assess the condition of the gallbladder and bile ducts. It is important to identify the concentration of bilirubin, and especially its bound form. If its amount has increased, then a thorough medical examination is necessary. In addition, it is important to determine the level total bilirubin(bound and unbound form). This indicator will help identify stones in the organs of the biliary system. In addition, it is used to determine the concentration of cholesterol, protein. Based on these indicators, it is possible to identify disorders in the functionality of the liver.
• OAM (general urinalysis). With the help of this study, you can also assess the state of the body, identify various diseases at an early stage. If the urine darkened, then this indicates an increase in the concentration of bilirubin. When such a symptom appears, you should consult a doctor. It indicates pathologies of the hepatobiliary tract, which threaten with dangerous consequences.

To assess the work of the gallbladder, it is necessary to determine the amount of urobilin (a derivative of bilirubin) in the urine. If its concentration has decreased or the substance is absent, then this sign indicates that the outflow of hepatic secretion from the gallbladder into the intestine has been disturbed. As a rule, this occurs when the bile ducts are blocked by calculi or when they spasm.

A coprogram is a study of human feces. Using this diagnostic method, it is possible to identify functional disorders of the gastrointestinal tract. Due to blockage of the bile ducts, human stools become discolored and acquire a greasy texture. This is due to the fact that without bile, lipids from food are not broken down and absorbed by the body. As a result, the stool becomes greasy. In addition, the liver secretion contains stercobilin (a precursor of bilirubin), which gives the excrement its characteristic color. If stercobilin is absent, then this indicates a blockage of the bile ducts or liver disease.

In addition, the following markers are examined to identify GB pathologies: alkaline phosphatase, C-reactive protein, aspartate aminotransferase (AsAT), alanine aminotransferase (ALAT). An increase in the concentration of the first substance indicates diseases of the gallbladder and liver. The amount of C-reactive protein increases with inflammation. And with the help of the last two markers, you can evaluate the functionality of the liver.

duodenal sounding

This is an informative research method with which you can assess the state of the biliary system. Diagnosis consists in the fact that the doctor collects bile and identifies the time during which it was allocated. At the same time, doctors pay attention to its consistency, shade, quantity, and determine whether there are impurities and inclusions in it. If white flakes are present, then it is sent for microbiological analysis. This is necessary to identify the bacterial components that provoked the disease. In addition, this analysis will determine how susceptible bacteria are to antibiotics.

Duodenal sounding will help to identify the bacterial components that provoked the disease

With the help of duodenal sounding, indirect signs of cholecystitis can be detected. Turbid bile with flakes testifies to the pathology. In addition, the ph of the secret decreases and sand is present in it.

Duodenal sounding will reveal evacuation-motor disorders of the organs of the biliary system.

Ultrasound of the biliary system

With the help of ultrasound, the gallbladder is studied, while important the following criteria: the size of the organ, its location. In addition, wall thickness, deformation can be identified. This informative study makes it possible to identify leakage of perivesical tissues with bile, an excess of the gallbladder, stagnation of the hepatic secretion, cholesterol plaques on the walls of the organ, calculi, and tumors. Thus, with the help of ultrasound, the liver, gallbladder and biliary tract are examined.

Ultrasound will assess the condition of the liver and gallbladder

In addition, do not forget about the gas that fills the cavity of the gallbladder. Ultrasound with a choleretic breakfast will reveal a certain type, which is associated with a violation of the contraction of the gallbladder and its ducts.

You can examine the gallbladder using computed tomography. But according to doctors, this diagnostic method does not have any special advantages over ultrasound.

Gallbladder scintigraphy

The examination, with the help of which they study the anatomy and physiology of the biliary tract, the motility of the gallbladder, the degree of patency of the bile ducts, is called scintography. According to the method, a radioactive isotope is injected into the patient's body intravenously. The drug is metabolized by the liver cells and excreted into the biliary system. Scanning is performed at intervals of 10-15 minutes for 1-2 hours.

Scintigraphy is a highly informative non-invasive diagnostic method

With the help of dynamic scintography, the movement of bile from the gallbladder is monitored. Unlike ultrasound, scintography does not reveal stones in the biliary tract. And in patients who took alcohol before the study, a false-positive result may appear.

As a rule, during scintography, the condition of the gallbladder and liver is assessed.

Additional Research

The study of the gallbladder and bile ducts can be carried out using magnetic resonance imaging. X-ray examination is less effective method diagnosis compared to MRI. X-rays will be more informative with the use of a contrast solution that penetrates the biliary system, mixes with bile and delays x-rays. overview shot abdominal cavity done with suspicion of perforation of the gallbladder. In this way, calculous cholecystitis (stones in the gallbladder) and calcification (accumulation of calcium on the walls of the organ) can be excluded.

MRI can help evaluate the functioning of the gallbladder

Magnetic resonance imaging will help evaluate the work of the gallbladder, identify anatomical changes in the organ (neoplasms, deformity, functional disorders). Stones are detected using MRI. MR cholangiography will allow you to get a two- or three-dimensional picture of the gallbladder and its pathways.

In addition, ERCP (endoscopic retrograde cholangiopancreatography) is used to diagnose gallbladder diseases. It can be used to identify obstruction of the bile and pancreatic ducts. To assess the state of the biliary tract, the following radioisotope studies are used:

• Cholescintography is an X-ray examination of the gallbladder using a contrast solution. It is used to detect inflammation of the gallbladder with an acute course or a "disabled" gallbladder (a condition in which bile does not flow into the gallbladder and is not released from it). This picture is observed after removal of the gallbladder.
• Radionuclide cholestography allows to determine the motility disorders of the gallbladder and its ducts.
• Intravenous cholangiocholecystography is used to identify the "disconnected" bile. In addition, with the help of research, stones in the bladder or its bile ducts are detected.
• Oral cholecystography is an x-ray diagnostic study using a contrast solution, which can be used to obtain a picture of the gallbladder. It is prescribed for suspected dyskinesia, inflammation of the neck of the gallbladder.

The last 2 techniques are rarely used in modern medicine.

In addition, it is important to establish a differential diagnosis.

Gallbladder diseases

Physicians allocate typical diseases, which are revealed in the study of the biliary system:

• cholecystitis. As a result of the penetration of pathogenic microorganisms into the gallbladder, an inflammatory process develops. As a result, the walls of the organ thicken. This ailment is manifested by pain on the right under the ribs, fever, constipation.
• Gallstone disease (GSD). Sometimes during the diagnosis, sand, thick bile or stones are detected in the gallbladder. This is due to a violation of the outflow of hepatic secretions as a result of blockage of the bile ducts or a violation of the contraction of the organs of the biliary system. This provokes stagnation of bile and the formation of stones. The formations block the lumen of the excretory duct of the gallbladder and provoke jaundice.

During the diagnosis of gallbladder, many diseases are detected.

GSD is manifested by jaundice, cutting or stabbing pain in the gallbladder, which radiates to the upper limb or shoulder blade. Sometimes the pain spreads throughout chest, then the patient mistakenly believes that his heart hurts.

• GD dyskinesia. With this disease, the contractility body, its ducts, there are problems with the work of the sphincter of Oddi. As a result, there are disorders of the outflow of bile. Autonomic dysfunction, diseases of the gallbladder or endocrine glands can provoke pathology.
• Obstruction of the biliary tract th. The hepatic secret cannot penetrate into the gallbladder and duodenum 12 in the presence of calculi. Characteristic signs of the disease are pain in the right side of the abdomen, yellowing of the skin and sclera, discoloration of feces, darkening of urine.
• Polyps in the gallbladder. Pathological growths of the epithelial tissue disrupt the movement of bile, as a result, it is difficult to release it into the duodenum. This disease can be confused with gallstone disease.

These are the most common diseases that are diagnosed during the study of the gallbladder.

A detailed description of the method is carried out on the basis of several main criteria. It describes what the work of the technique is based on, what information the doctor will receive with its help, the mechanism for carrying out the manipulation itself.

Blood chemistry

The method is based on the study of the levels of liver enzymes and bilirubin. Diagnosis of the gallbladder involves the study of the level of alkaline phosphatase (AP), gamma-glutamyl transferase (GGT), cholesterol.

An increase in the values ​​of the above enzymes and the fraction of direct bilirubin indicates stagnation of bile (cholestasis). All indicators or only some can increase.

To differentiate liver damage, the activity of alanine aminotransferase (AlT), aspartate aminotransferase (AST) is also examined. The analysis requires blood sampling exclusively from a vein.

Ultrasonography

Now this method is one of the "gold standards" for diagnosing pathologies of the bile ducts, gallbladder and many other diseases. The work is based on the fact that the device generates specific ultra sound waves that pass through body tissues.

Organs with different density unequally reflect ultrasound waves, which allows you to visualize the structure of the organ on the monitor, evaluate its size and structure. In addition to the structure, the method is able to provide information about the presence of calculi in the gallbladder, assess its tone, size, and function.

The main advantages of the study:

• sufficient information content;
• safety and comfort for the patient;
• absence age restrictions;
• speed of execution;
• low price compared to other surveys.

Its disadvantage will be the human factor, since the ultrasound doctor interprets the information from the monitor. Thus, the result directly depends on his qualifications and experience, as well as on the technical characteristics of the equipment.

duodenal sounding

Nowadays, the method is rarely used, since most doctors prescribe an ultrasound. It should be noted that duodenal sounding is forgotten extremely unfairly.

This is a complex manipulation that allows you to qualitatively and quantitatively evaluate all three fractions of bile (A, B, C), determines the level of enzymes in the duodenal content. As a result, it is possible to identify both functional and organic pathology of the biliary tract and gallbladder.

The patient swallows a gastric tube (preferably a double one) up to the level of 40 cm, in this position the probe advances another ten centimeters, the specialist takes the content. Then the person continues swallowing the probe up to the mark of 70 cm and lies down on the right side, having previously placed a roller under the pelvic ring.

A heating pad is necessarily placed under the right hypochondrium for a better outflow of bile. For an hour, the probe advances another twenty centimeters, after which the contents of the duodenum begin to flow into the container.

The advantages of the method are the following features:

• good information content;
• relative safety for the patient;
• low price.

The main disadvantages will be discomfort for the patient, high requirements for the qualifications of the personnel performing the manipulation, limited use in comorbidities.

X-ray technique

Cholecystography - X-ray method study, which has also become rarely used since the advent of ultrasound. A contrast agent is injected into the digestive tract.

A series of x-rays is taken in real time, which allows you to visualize the organ and evaluate its functional abilities. Due to this, the doctor receives information about the ability of the gallbladder to concentrate bile, its mobility and contractility, and the formation of X-ray positive stones.

A person drinks a contrast agent, which then enters the bile. Next, the specialist takes a series of pictures after a certain time.

Advantages:

• comfort for the patient;
• sufficient information content;
• adequate price.

The disadvantages of holography include the inability to visualize X-ray negative calculi and the patient receives insignificant radiation.

Dynamic scintigraphy

Cholecsintigraphy is a relatively new technique with which it is possible to examine the gallbladder, identify the pathology of its structure and function, bile ducts, and track the dynamics of bile movement. In addition, the synthetic function of the liver is determined.

The essence of the study is to track the movement of a specific radionuclide, which is administered intravenously. After that, several x-rays are taken. The method is used for diseases of the gastrointestinal tract, requiring more accurate visualization than simple studies give.

Cholecystography is a method of studying the anatomy and function of the bile ducts and bladder using x-rays and a contrast agent. The contrast is the drug Bilitrast (orally) or Bilygnost (intravenously), which consists of 52% iodine, which allows it to illuminate the organ from the inside on x-rays.

Thus, the radiologist can see the shape, position and size of the bladder, its ability to concentrate bile and contract after ingestion. fatty foods.

This diagnostic method has existed for almost a century, and during this time has proven its effectiveness and safety. In addition, the research technology is relatively simple.

Today, cholecystography has become less common, which was facilitated by the development of other diagnostic methods, such as ultrasound and radioisotope cholegraphy.

Purpose of diagnosis

The purpose of the diagnostic method is to identify bladder pathologies:

• biliary dyskinesia - a pathology in which a violation of the motility of the organ leads to a violation of the excretion of bile through the ducts;
• cholelithiasis - the method is used to identify stones and evaluate the function of the bladder pathology;
• tumors of the bladder and the functioning of the organ against their background.

The indication for the appointment of the procedure can be both an already diagnosed pathology (control of the ongoing treatment), and the patient's complaints of pain in the hypochondrium, impaired digestion of fats (primary diagnosis).

Contraindications

The procedure is contraindicated in the following cases:

• pregnancy and lactation;
• chronic renal failure;
• chronic liver failure;
• cardiovascular failure;
• allergy to a contrast agent;
• jaundice;
• bladder perforation and biliary peritonitis;
• cirrhosis of the liver;
• acute cholangitis (inflammation of the bile ducts).

Causes of blockage of the bile ducts

Both obstruction of the biliary tract from the inside and compression from the outside can cause obstruction of the biliary tract. A mechanical obstruction to the outflow of bile can be complete or partial, the brightness of clinical manifestations depends on the degree of obstruction.

The pathogenesis of blockage of the bile ducts is multicomponent, the inflammatory process in the biliary tract usually serves as the beginning. Inflammation leads to thickening of the mucosa, narrowing of the lumen of the ducts.

If at this moment a calculus enters the ducts, it cannot leave the choledoch on its own and causes a complete or partial blockage of its lumen. Bile begins to accumulate in the bile ducts, causing them to expand.

From the liver, bile can first enter the gallbladder, greatly stretching it and causing an exacerbation of the symptoms of cholecystitis. If there are stones in the gallbladder, they can enter the cystic duct and block its lumen.

In the absence of outflow of bile through the cystic duct, empyema or dropsy of the gallbladder may develop. An unfavorable prognostic sign for blockage of the biliary tract is the secretion of whitish mucus (white bile) from the mucous membrane of the choledochus - this indicates the beginning of irreversible changes in the bile ducts.

Caused by obstruction of the biliary tract, the problem is not only the formation of an internal blockage, but also as a consequence of external pressure. Doctors highlight a complete or partial mechanical obstruction to the outflow of bile. Moreover, its degree will depend on what clinical manifestations are observed at the moment.

It is already known that there whole line diseases that can lead to impaired patency, resulting in intrahepatic pain as a result of the absence or incomplete flow of bile from the liver into the duodenum.

Varieties of techniques

The classification of cholecystography methods is carried out according to the method of contrast administration. This can be done in 4 ways.

If the human body does not respond well to the components of the preparation for contrast, it should replace the x-ray of the gallbladder with other diagnostic methods, such as ultrasound.

Oral

Oral cholecystography suggests that the patient drink a solution of the drug Bilitrast 12 hours before the study, washing it down with sweetened water or tea.

2 The main causes of the development of the disease

The development of blockage of the bile ducts does not occur at once - it consists of many links. In most cases, the process begins with the initiation of inflammation in the biliary tract.

This leads to the fact that their mucous membrane gradually thickens, gathers into pronounced folds, which, in turn, leads to a narrowing of the cross section (lumen) of the ducts. Since bile undergoes changes when the pathological process is started, in parallel, first a fine sediment is formed in it, then sand and, finally, stones.

If at least one stone gets into the "trap" of the folds of the thickened mucous membrane of the ducts, it cannot independently move in the direction from the choledochus to the duodenum 12 and clog (fully or partially) its lumen.

Under these conditions, the outflow of bile is blocked, because of which it begins to accumulate in the bile ducts, press from the inside on their walls and stretch them. Once in the gallbladder, stagnant bile also puts pressure on its wall and exacerbates inflammation of the mucous membrane.

In turn, the stones in the gallbladder enter the cystic duct and block its lumen. Since bile accumulates more and more in the gallbladder, its dropsy is formed, and when an infection is attached, empyema (purulent inflammation) is formed.

Bile, accumulating in the intrahepatic ducts, sooner or later begins to put pressure on the liver cells and destroy them. From the destroyed cells, bile acids and bilirubin (bile pigment) enter the bloodstream.

Signs of the disease

There are several stages in the development of gallbladder disease. Based on the stage, signs of the disease can be detected. Usually there is enough intense pain, which becomes the main symptom. Moreover, it happens not only in the right side of the abdomen, it can manifest itself in the entire abdomen, giving cramps to the stomach and other unpleasant sensations.

Often, an attack of such a disease can be accompanied by profuse vomiting, regardless of the stage of the disease. The sensation in the mouth of bitterness after vomiting becomes characteristic, while the color of the vomit is usually yellow, saturated. Noticeably strong intestinal disorder, accompanied by dysbacteriosis. There may be problems with urination, constipation.

Attacks are often accompanied by a sharp yellowing of the skin and eyes. This phenomenon itself passes after the phase of a sharp exacerbation.

It should be noted that the abrupt phase can come unexpectedly, often without provocative circumstances. True, it is possible to identify the presence of disorders in the work of the gallbladder long before the onset of an attack.

Nausea, a feeling of discomfort, slight pressure on the right may indicate a violation of the work of this organ. In some cases, to cope with the disease, it is enough to follow a light diet.

Cause discomfort there may be a lack or excess of cholesterol.

Basically, sick people complain to the therapist about frequent nausea before and after meals; the frequent release of bitterness from the esophagus; for frequent indigestion.

If a person develops such symptoms, the therapist recommends an examination by a gastroenterologist.

This is where it will be assigned complete diagnostics gallbladder, according to which the specialist will be able to determine the onset of the pathology.

According to medical statistics, about 20% of the studied people experience this phenomenon. And most of them are women.

What are the symptoms of gallbladder disease? Most diseases of the gallbladder have common symptoms.

Patients may experience the following symptoms:

Diagnosis of the gallbladder

Initial manifestations blockages of the bile ducts resemble the symptoms of cholecystitis or biliary colic, with which the patient may be hospitalized in the gastroenterology department. Preliminary diagnosis is carried out using such a simple and safe method as ultrasonography of the pancreas and biliary tract.

If biliary calculi, enlargement of the choledochus and intrahepatic bile ducts are found, MR-pancreatocholangiography and computed tomography of the biliary tract may be required to clarify the diagnosis.

To clarify the cause of obstructive jaundice, the location of the calculus, the degree of obstruction of the biliary tract, percutaneous transhepatic cholangiography, dynamic scintigraphy of the hepatobiliary system is performed.

They allow you to detect a violation of the dynamics of bile, its outflow from the liver and gallbladder.

The most informative method for diagnosing obstruction of the bile ducts is retrograde cholangiopancreatography. This technique includes simultaneous endoscopic and X-ray examination of the biliary tract.

If stones are found in the lumen of the duct during this procedure, the stones can be extracted from the choledochus. In the presence of a tumor that compresses the bile duct, a biopsy is taken.

In biochemical samples of the liver, there is an increase in the level of direct bilirubin, alkaline phosphatase, transaminases, amylase and blood lipase. Prothrombin time is prolonged. In the general analysis of blood, leukocytosis with a shift of the leukoformula to the left, a decrease in the level of erythrocytes and platelets can be detected. A significant amount of fat is found in the coprogram, bile acids are absent.

Conventional MRI:

Due to the fact that this disease has symptoms similar to most liver diseases (jaundice), as well as gastrointestinal tract(vomiting, nausea), then its diagnosis has its own characteristics.

It is important to understand that with any incomprehensible symptoms, you should immediately consult a doctor and undergo a comprehensive examination that will help identify cholecystitis.

Diagnostics this disease happens like this:

• There is a primary examination by a doctor, at which the specialist determines the further course of research.
• An analysis of asd, as well as blood, is prescribed. Asd itself is special study, which is carried out in all cases where there is a suspicion of liver or gallbladder disease. The study of asd will help to identify abnormalities that are present in the gallbladder.
• Your doctor may order an ultrasound or computed tomography. Such studies are the same and cannot be administered simultaneously. If the doctor recommends doing so, then he wants to make money on the patient.
• Internal examination using a special probe that the patient swallows. The probe takes samples of bile, which are then examined.
• Radiological examination, which involves taking a special drug that contains radionuclides that are safe for the body. They enter the circulatory system and are delivered to the gallbladder, after which it is done spectral analysis bile, and the walls of the gallbladder.
• X-ray. With it, you can determine the thickening of the walls of this organ, the presence of stones, as well as blockage of the bile ducts.

As you can see, there are many ways to diagnose this disease.

But in practice, the most used blood test, asd, as well as ultrasound (ultrasound) or computed tomography.

Particular attention is paid to asd, since, namely, the study of asd is able to identify any pathology of the liver and gallbladder. The analysis of sd is also called a liver test for the presence of jaundice and other liver pathologies (cirrhosis).

For the diagnosis of the liver and gallbladder for the possibility of detecting pathologies of a different nature, advanced research methods are used, which make it possible to timely identify a developing disease. For a successful cure, it is very important to carry out the tests and medical examinations prescribed by the doctor observing the patient without delay, in as soon as possible.

The main instrumental research methods:

1. 1. Duodenal sounding occupies a very important place in checking the condition of the biliary system. During this procedure, bile is collected, the time during which it was allocated is determined. Then its consistency, color, volume, presence or absence of impurities and inclusions is evaluated. If inclusions in the form of white flakes are found, the bile collected during the procedure is sent for microbiological analysis to identify the causative agent of the disease and confirm the diagnosis.
2. 2. Ultrasound. During this procedure, the thickness of the walls of the gallbladder, its shape and location, the presence or absence of kinks are determined. Sometimes stones are found in the cavity of this organ. This study allows us to say a lot about the state of the biliary system, the violation of its work and the presence of the disease. Often, thanks to ultrasound, the presence of gallstone disease or an inflammatory process is detected or confirmed.

In addition to these two methods, x-ray examination of the gallbladder, cholangiopancreatography and computed tomography are sometimes used.

X-rays are used to find stones in the gallbladder and to evaluate its work. Cholangiopancreatography is necessary to examine the exit site of the bile duct into the duodenum and is used if a blockage is suspected. Computed tomography is used when other types of instrumental examination cannot be applied to the patient due to contraindications.

Complaints with blockage of the biliary tract are quite typical and allow the doctor to make a diagnosis with a high degree of probability. Confirmation of the diagnosis will help the data of the physical examination of the patient - examination, palpation (palpation), percussion (tapping) and auscultation (listening with a phonendoscope) of the abdomen, as well as instrumental and laboratory diagnostic methods.

What tests to take to check the liver and gallbladder

If there are signs indicating a possible damage to the liver or gallbladder, you should contact your local therapist and undergo a comprehensive examination.

What tests do you need to take to check the liver and gallbladder to identify possible pathologies?

List of tests and studies for liver diseases:

• General blood analysis.
• blood glucose.
• Coagulogram.
• Viral hepatitis markers.
• General urine analysis.
• Urine for bile pigments.
• Coprogram.
• Feces for occult blood.

List of tests and studies for diseases of the gallbladder:

• General blood analysis.
• blood glucose.
• Coprogram.
• Fibrogastroduodenoscopy.
• Ultrasound of the abdominal cavity, if necessary, a test breakfast with dynamic monitoring of the contractility of the gallbladder.
• Duodenal sounding with microscopy and bile culture.

Additional tests for liver and gallbladder disease after cholecystectomy (surgical removal of the gallbladder) are tests for bilirubin, cholesterol, triglycerides, alkaline phosphatase, transaminases, amylase, and bile pigments. Also, an additional analysis for the liver and gallbladder is general study urine.

Modern methods of studying the liver and gallbladder

Modern methods of diagnosing diseases of the liver and gallbladder include ultrasound. In the vast majority of cases, ultrasound is sufficient to detect gallstones, determine their size, number, location, and the presence or absence of signs of inflammation.

This method of studying the liver and gallbladder does not require complex preparation, has no contraindications, and is absolutely painless.

The probability of finding stones in the gallbladder reaches 96%. In addition, ultrasound examination can collect information about neighboring organs.

Other methods for diagnosing diseases of the liver and gallbladder include: radiographic or fluoroscopic examination, radiography with the introduction of a contrast agent (if the patient is not allergic to a contrast agent), computed tomography of the abdominal organs.

It is clear that at the moment the main method of examination of the gallbladder is ultrasound. But no matter how good the method is, the apparatus is modern, the doctor is qualified, the patient needs to prepare for it in the most thorough way.

Due to the fact that this disease has symptoms similar to most diseases of the liver (jaundice), as well as the gastrointestinal tract (vomiting, nausea), its diagnosis has its own characteristics.

Diagnosis and treatment of diseases of the gallbladder is carried out by a general practitioner, gastroenterologist, surgeon or hepatologist. First of all, if symptoms of diseases of this organ appear, you need to contact a general practitioner who, if necessary, will refer you to related specialists.

During an objective examination, the doctor necessarily performs palpation of the liver and gallbladder, with which you can determine pain points, that is, cystic symptoms, namely:

• Kera's symptom - pain during palpation of the gallbladder on inspiration;
• Georgievsky-Mussi symptom - appearance pain when pressing on a point that is located between the legs of the right sternocleidomastoid muscle;
• symptom of Ortner-Grekov- pain is provoked by tapping the edge of the palm on the right costal arch.

But complaints, anamnesis and objective data will not be enough to make an accurate diagnosis, so the following additional studies are prescribed for patients:

• general blood analysis, which is used to determine blood changes characteristic of the inflammatory process in the body;
• general and biochemical analysis of urine allows you to detect an increased level of urobilinogen;
• the coprogram will show violations of the digestive function;
• duodenal sounding. This method is performed using a thin rubber tube that is placed through the mouth into the duodenum to collect portions of bile.
• chemical analysis of bile used to study its composition.
• bile culture suggests the etiology of the disease;
• ultrasound examination of the abdominal organs. Using this method, you can study the anatomical features of the gallbladder and identify organic changes, inflammation and the presence of stones.
• biopsy, which is performed with a thin needle under ultrasound guidance. The resulting material is examined under a microscope for the presence of cancer cells.
• cholangiography is an x-ray contrast study of the gallbladder and bile ducts;
• CT scan used mainly in gallbladder cancer to assess the prevalence of screenings.

Tests for cholecystitis

Cholecystitis is an insidious disease that has diagnoses similar to other diseases of the intestinal tract and stomach. If it is not diagnosed in time, then even a fatal outcome may occur or the gallbladder will be removed. Therefore, when incomprehensible symptoms appear, it is better to consult a doctor.

• General blood analysis.
• blood glucose.
• Coagulogram.
• Biochemical blood test: bilirubin (total, direct, indirect); cholesterol; triglycerides; alkaline phosphatase; transaminases; total protein and protein fractions; urea.
• Viral hepatitis markers.
• General urine analysis.
• Urine for bile pigments.
• Coprogram.
• Feces for occult blood.
• Fibrogastroduodenoscopy and fluoroscopy of the esophagus and stomach to determine varicose veins of the esophagus and stomach.
• Ultrasound of the abdominal cavity with the definition of signs portal hypertension.
• Conducting a survey to identify alcohol abuse.

Gallbladder problems occur in 300 people per 100,000 people. Timely detection of the disease is very important. Not the last place in the diagnosis of this group of diseases is occupied by analyzes, since they are the most informative and allow you to fairly accurately establish the presence of violations in the work of this organ.

In addition to the above analyses, diagnostic purposes other, less well-known, are also considered: tests for alkaline phosphatase, C-reactive protein, AST and ALT. An increase in alkaline phosphatase indicates not only the pathology of the gallbladder, but also problems with the liver.

The level of C-reactive protein increases with inflammatory process, in particular, may indicate inflammation in the gallbladder. AST and ALT are important indicators of liver function.

There are many studies looking at the gallbladder. All these analyzes help to understand quite accurately whether there are violations in the work of this body or not.

It is worth recalling that in order to make a diagnosis, it is not enough to undergo any one of the studies presented above. One type of examination should complement the other. Only in this case will an objective picture of the patient's state of health be obtained.

And some secrets.

A healthy liver is the key to your longevity. This body performs a huge number of vital functions. If the first symptoms of a disease of the gastrointestinal tract or liver were noticed, namely: yellowing of the sclera of the eyes, nausea, rare or frequent stools, you simply must take action.

Checking the liver should become habitual for every modern person. preventive measure, because doctors say that absolutely all people are now at risk of diseases of this patient vital organ.

Doctors attribute the threat to poor ecology, alcohol consumption, especially low-quality alcohol, a large amount of fatty foods and irregular, malnutrition. Also increase the likelihood of disease passive lifestyle, sedentary work and lack of physical activity.

Most people suffer from liver diseases, someone pays attention to them and goes to the doctor, while someone stays with their problems and waits for everything to go away by itself.

Of course, this does not happen, any disease has its onset, remission and chronicity with untimely treatment.

To avoid this, it is necessary to consult a doctor at the first symptoms of the lesion. The attending physician will prescribe the necessary tests for the liver, with the help of which you can find out how serious the disease is.

Liver tests can clearly indicate the pathology. The check will not take long.

What are liver diseases?

Regarding the lesion, in most cases, people suffer from biliary disorders (biliary dyskinesia, calculous and non-calculous cholecystitis).

How to check the liver if there is a suspicion of a serious disease of this most important organ? Liver problems can go unnoticed for a long time, because there are no nerve endings in its tissues and the pain syndrome manifests itself already on final stages lesions, when the organ increases in size, deforms and begins to put pressure on its own shell (glisson capsule).

Today we’ll talk about how to check the condition of the liver, what tests you need to pass for this, and what alarming symptoms to pay attention to in order to seek medical help in a timely manner.

Common signs of liver problems

The liver is the main filter of our body. This is the most major gland, which plays an important role in the processes of digestion and metabolism, is responsible for cleansing the blood of allergens, toxic and poisonous compounds, is a kind of "depot" in which reserves of glycogen, vitamins, microelements necessary to provide the body with energy are deposited.

The list of its functions includes the neutralization and removal of excess hormones and vitamins from the body, the regulation of carbohydrate metabolism, the synthesis of cholesterol, lipids, bilirubin, as well as bile and other hormones and enzymes involved in the digestion process.

IN last years Physicians note with alarm a significant increase in diseases associated with the liver. Most often, fatty hepatosis, toxic and alcoholic lesions are diagnosed, the development of which leads to malnutrition, bad habits, unhealthy lifestyle.

If the liver functions are disturbed, the volume of toxins and other harmful substances in the blood increases, and the body literally begins to poison itself. Against the background of intoxication, the general state of health worsens and characteristic complaints appear.

Treatment with folk remedies

All patients with blockage of the bile ducts require consultation with a gastroenterologist and a surgeon. After all the examinations, finding out the localization and degree of obstruction, tactics are determined surgical treatment.

If the patient's condition is severe, it may be necessary to transfer him to the department intensive care for antibacterial, infusion and detoxification therapy. Before the patient's condition stabilizes, an extended operation can be dangerous, therefore, non-invasive techniques are used to facilitate the outflow of bile.

These include extraction of bile duct calculi and nasobiliary drainage with RPCG (through a probe inserted above the site of bile duct narrowing), percutaneous puncture of the gallbladder, cholecystostomy and choledochostomy.

If the patient's condition does not improve, a more complex intervention may be required: percutaneous transhepatic drainage of the bile ducts.

After the patient's condition returns to normal, the use of endoscopic treatment methods is recommended. During endoscopy, expansion (endoscopic bougienage) of the biliary tract is carried out with their cicatricial stenosis and tumor strictures, the introduction of a special plastic or mesh tube into the biliary tract to preserve their lumen (endoscopic stenting of the common bile duct).

In case of obstruction of the cicatricial narrowed papilla of the duodenum with a calculus, endoscopic balloon dilatation of the sphincter of Oddi may be required.

If stones and other obstructions to the outflow of bile cannot be removed endoscopically, an extended operation is required. During such surgery, the choledochus is opened (choledochomy), so in the future it is necessary to prevent leakage of bile through the sutures of the bile duct into the abdominal cavity.

For this, external drainage of the bile ducts is performed according to Ker (T-tube), and after cholecystectomy - external drainage of the bile ducts according to Halsted (polyvinyl chloride catheter inserted into the stump of the cystic duct).

If timely surgical treatment of blockage of the bile ducts is not carried out, the patient may develop sepsis, bilirubin encephalopathy, cirrhosis of the liver, liver failure (with complete blockage of the bile ducts - acute, and with partial - chronic).

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Since signs of even minor blockage of the biliary tract can signal the development of serious consequences, such a patient should be hospitalized in the department of surgery.

Treatment methods used:

• operational;
• conservative.

Conservative methods of treatment for blockage of the biliary tract are considered auxiliary - the fundamental is surgical tactics. There are cases when the blockage of the bile ducts passed by itself (for example, a clot of mucus or a calculus left the duct on its own), but this does not mean a cure - sooner or later the blockage will recur. Therefore, its cause should be eliminated.

Since immediate relief of the outflow of bile is required, non-invasive (non-surgical) methods are used, such as:

• extraction (extraction) of stones from the biliary tract through a probe and subsequent drainage through a nasobiliary probe (introduced through the nose);
• percutaneous puncture (puncture) of the gallbladder;
• cholecystostomy (anastomosis between the gallbladder and the external environment);
• choledochostomy (anastomosis between the main bile duct and the external environment);
• percutaneous transhepatic drainage.

• laparoscopy– interventions with the help of a laparoscope (probe with built-in optics);
• laparotomy - operations with the opening of the abdominal cavity.

The endoscopic method is less traumatic - with it, all manipulations are carried out through several small holes in the abdominal wall. It is not used in complicated cases when it is necessary to switch to an open method of operation, during which the operating surgeon will have more freedom of action.

Also, the operation is switched to the open method if the result cannot be achieved with the help of an endoscope due to technical reasons. During open method carry out the same manipulations as during laparoscopic.

All patients must be prescribed a diet, the principles of which we will discuss below.

Etiotropic treatment consists in the use of drugs that are aimed at eliminating the cause. With cholecystitis, antibiotic therapy is indicated, with stones, carcinoma or polyps of the gallbladder - surgery.

Pathogenetic treatment consists in the use of drugs that normalize the functioning of the gallbladder. For this purpose, antispasmodic, detoxifying, anti-inflammatory and enzymatic drugs can be used.

Symptomatic treatment involves the appointment of painkillers, choleretic, antipyretic and other drugs. For pain, drugs such as Ketonal, Baralgin, Drotaverin, Spasmolgon and others can be used.

Folk remedies will be an excellent addition to traditional therapeutic measures.

Even specialists often supplement the traditional therapy of gallbladder pathology with phytotherapy. To your attention the recipes of the most effective means and indications for their use.

Diagnosing bile duct problems is a difficult process. All organ diseases have similar symptoms. Diagnostic measures necessarily include general blood, urine and stool tests.

In addition, to determine the causes of blockage, narrowing or expansion of the bile ducts, the doctor, depending on the need and the availability of the required equipment, prescribes:

• ultrasound examination of the liver, gallbladder and ducts;
• radiograph of the abdominal cavity;
• liver biopsy;
• computed tomography of the abdominal organs.

Without a correct diagnosis, treatment of the bile ducts is ineffective. Therapy depends on the nature of the disease. Bile duct obstruction is treated surgically. It is often difficult to do without operations even in the case of the formation of stones or with advanced inflammation. With the help of surgical intervention, cysts, benign and malignant neoplasms are removed.

In the case of expansion of the intrahepatic bile ducts or extrahepatic, therapy is carried out in a complex manner. First of all, the causal channel changes are eliminated. Further, therapy is aimed at narrowing the gaps.

Depending on the disease, treatment is carried out using the following methods:

1. Conglomerates in channels. Dieting. Fatty and spicy foods are excluded from the diet. The patient needs to monitor their weight. The patient is prescribed drugs based on ursodeoxycholic acid. To relieve pain symptoms, the patient takes antispasmodics and analgesics. In some cases, antibiotic therapy is performed.
2. Chronic cholecystitis. Strict adherence to the diet. With exacerbation of bed rest. The therapy includes antibacterial, antisecretory and enzyme preparations. Antispasmodics are used to relieve symptoms.
3. Biliary dyskinesia. In this case, choleretic drugs and funds for plant-based. As in the first two cases, a diet is prescribed. Antispasmodics and sedatives are used.
4. Acute cholangitis. For removal pain symptom use antispasmodics and painkillers from narcotic and non-narcotic groups. Antibiotics are prescribed broad action, enzymes and antipyretics.

According to the rules of the diet, foods with great content cholesterol and fats. Also, you can not eat fried, salty, spicy and pickled dishes. Coffee and strong tea are excluded. Preference is given to vegetables, low-fat fish and drinks based on herbs, berries and fruits.

4 Methods of therapy

If during the study a blockage of the bile ducts was detected, then an additional consultation with a gastroenterologist or surgeon may be required. Only this allows not only to determine the severity of the disease, but also to prescribe treatment.

Moreover, if a severe form of the disease is detected, the patient should be transferred to the intensive care unit, and an antibacterial, infusion and detoxification form of therapy should be carried out.

This is due to the fact that before carrying out surgical treatment, it is required to stabilize the patient's condition in order to avoid the risk of complications or even death.

In order to facilitate the outflow of bile, it is necessary to use various non-invasive techniques. This may be the extraction of calculi of the bile ducts or nasobiliary drainage using a special probe, cholecystostomy and choledochostomy.

If the patient is in a satisfactory condition, or relief has come, then endoscopic treatment methods are used for treatment. At the same time, during endoscopy, all clogged ducts will be expanded, which is the introduction of a special plastic or mesh tube into the biliary tract.

In some cases, endoscopic balloon dilatation of the so-called sphincter of Oddi is necessary.

Except surgical methods ways to improve the passage of bile traditional medicine. Traditional medicine does not consider them particularly effective, and therefore they cannot fully replace traditional surgical treatment.

The folk remedies include Apple vinegar. 1 st. l. for 1 glass apple juice allows you to relieve pain in the gallbladder and its ducts.

If 4 tbsp. l. mix lemon juice with a glass of water, then you need to drink the remedy on an empty stomach in the morning. This treatment can continue for several weeks and should help to completely remove the stones from the body.

Decoction of dried leaves peppermint, infused for 5 minutes, will relieve pain and help get rid of stones.

A vegetable mixture in the form of juice from 1 beetroot, cucumber and 4 carrots can help to recover. All this is mixed and drunk 2 times a day for two weeks.

Procedure results

To clarify possible pathologies, determine the location of organs in the abdominal cavity, the smallest changes in tissues, narrowing of the bile ducts and the presence of possible stones, magnetic resonance imaging is used.

Cholecystocholangiography is prescribed by a doctor to diagnose possible pathologies internal organs. Suspicion of biliary dyskinesia is a direct indication for a study with the introduction of a contrast fluid.

If cholelithiasis is suspected, the patient is shown cholecystocholangiography in several images (during the passage of a contrast agent and after the organ is completely filled with iodine-containing liquid).

To obtain a complete picture of an oncological disease, an x-ray of the gallbladder and ducts is performed - the research method allows you to see neoplasms and metastases, to assess the degree of the disease.

Pain under the ribs and in the right side, which are aggravated by pressure, are examined using cholecystocholangiography. Also added are laboratory research taken biomaterials - a comprehensive examination allows you to establish a complete picture of the disease.

In case of violation of the digestion of fats, an x-ray is prescribed, which shows the state of the digestive system and bile ducts. Scheduled inspection allows you to see the dynamics in the treatment and assess the condition of the bladder with adjacent ducts.

The difficulty in performing cholecystocholangiography is the radiation dose that each patient receives. When X-rays pass through the human body, the level of radiation increases. When undergoing the procedure no more than once a year, this amount of radiation is not dangerous.

Unless absolutely necessary, the procedure is not performed for pregnant women in the first trimester. For children, cholecystocholangiography is prescribed in cases where the benefits of the information obtained during the study outweigh the risks of exposure. For children, additional protective aprons are used during scanning (protect the chest, thyroid gland and sexual organs).

A contraindication to the procedure is an allergy to the components of the contrast agent. Without liquid with iodine ions, cholecystocholangiography is not performed. A direct contraindication to the procedure is renal failure and the serious condition of the patient with liver pathologies. The procedure is contraindicated in patients with pathologies of the cardiovascular system.

Cholecystography is prescribed to study the anatomical structure of the gallbladder. Cholecystocholangiography covers not only the bladder, but also the excretory ducts.

On the resulting image, you can evaluate the shape and position of the area under study, the displacement of its position, which is deviated from the norm. The size of neoplasms and stones is estimated from several images taken in different planes.

A two-dimensional image allows you to evaluate the volumetric indicators of anomalous formations. The picture shows tumors and polyps that interfere with the work of the gallbladder or ducts.

Indications

An ultrasound of the gallbladder is prescribed by a gastroenterologist in the following cases:

• frequent pain in the right hypochondrium, which is not relieved by painkillers;
• feeling of heaviness or discomfort in the liver;
• feeling of bitterness in the mouth;
• yellowness of the skin and visible mucous membranes;
• severe malnutrition:
  • abuse of spicy, fatty, fried, smoked foods;
  • irregular meals;
  • overindulgence low calorie diets;
• long-term use medicines;
• deviation from the norm in laboratory blood tests (ALT, AST, bilirubin, etc.);
• cholelithiasis;
• biliary dyskinesia;
• abdominal trauma;
• various intoxications (poisoning) of the body, including alcohol abuse;
• monitoring the state of the biliary system in case of tumors or suspicion of a malignant process;
• when choosing and prescribing hormonal contraceptives (if a woman has a predisposition to gallbladder diseases, then taking birth control pills can accelerate the formation of a gallstone and provoke its inflammation. Therefore, gallbladder diseases are a relative contraindication to taking hormonal contraceptives);
• obesity;
• monitoring the effectiveness of treatment.

Note: patients with a removed gallbladder undergo a specialized ultrasound - dynamic echo-choledochography (ultrasound examination of the ducts with a food load).

In addition to severe damage to the skin in the study area (open wounds, burns, infectious lesions), there are no contraindications to the procedure.

Forecast

The prognosis for blockage of the biliary tract is favorable if the patient is promptly given correct diagnosis and provided assistance. The prognosis is difficult when:

• cancerous lesion of the common bile duct - it worsens the course of the disease and complicates the treatment;
• accession of infection and the development of purulent processes in the gallbladder and bile ducts;
• hasty surgical treatment in a serious condition of the patient, if infusion therapy has not been carried out;
• self-treatment at home with the involvement of "proven" folk methods .

Kovtonyuk Oksana Vladimirovna, medical commentator, surgeon, medical consultant

Proper nutrition

With all types of gallbladder disease and its course, dietary nutrition becomes the main component of therapy. Table No. 5 according to Pevsner is recommended for all patients.

In diseases of the gallbladder, diet is an indispensable component of treatment. All patients are assigned table number 5 according to Pevzner.

The diet for gallbladder pathology is as follows:

• eat fractionally, that is, in small portions 5-6 times a day;
• you need to drink a sufficient amount of liquid (at least 1.5 liters);
• during remission, it is recommended to reduce the proportion of fried, spicy and smoked foods in the diet;
• limit the proportion of fats in the diet, including vegetable origin;
• stop drinking alcohol and smoking;
• during exacerbation, it is forbidden to eat food and water. As the symptoms subside, food is resumed (50 ml of vegetable puree soup, 100 ml of unsweetened tea or fruit juice), gradually expanding the diet;
• exclude fresh bread and pastries from the menu, as well as ice cream, sweets, sweet soda and caffeinated drinks;
• the menu should be composed of soups-puree with vegetables, cereals, low-fat varieties meat, cereal, vegetable puree and stews, fruits, berries, vegetable salads, low-fat dairy products.

You can check the condition and functioning of the gallbladder using various laboratory and instrumental research methods. The need to use this or that method can only be assessed by the doctor after examining the patient.

In recent years, people have become more susceptible to diseases of the hepatobiliary tract. This is due to bad environment, bad habits, violation of the regime of work and rest, schedule and frequency of eating, wrong food habits. In youth, the body is able to cope with such loads, but its capabilities are not unlimited. Therefore, patients begin to experience problems with the gastrointestinal tract, including the gallbladder, somewhere in their thirties. The question becomes how to avoid this kind of trouble. To achieve this goal, it is necessary to choose the right gastroenterologist and have a general understanding of how to check the gallbladder.

An important principle of success in the fight against any pathology is the timely appeal to a specialist. A visit to the doctor is required if the following symptoms appear:

• feelings of bitterness in the mouth;
• heaviness in the right hypochondrium;
• pain under the right rib;
• stool disorders (constipation or diarrhea);
• general weakness and others.

To begin with, it is enough to come to an appointment with a family doctor or a general practitioner at a polyclinic. The specialist conducts a detailed survey of the patient and an objective study. It includes the following aspects:

• examination of the whole body;
• percussion (tapping);
• palpation (palpation);
• auscultation (listening).

After examination, a preliminary diagnosis is established, additional methods studies to establish a definitive diagnosis. Further work of the doctor is carried out after receiving the results of the examination.

The right approach and a brief description of the methods

The general practitioner will usually refer the patient to a specialist, i.e. a gastroenterologist. Any doctor adheres to a phased approach to diagnostic procedures, guided by the simplicity of the research methodology, its information content, invasiveness (injury) and financial factor.

This means that the examination of the gallbladder usually begins with simple, inexpensive and quite informative techniques:

• general analyzes ( clinical blood, urine, feces, coagulogram);
• blood chemistry;
• ultrasound examination of the abdominal organs (ultrasound);
• duodenal sounding;
• cholecystography.

In most cases, the above studies are sufficient to establish a definitive diagnosis. Do not forget that some diseases require more detailed visualization, so other informative methods are used. Such studies are not carried out everywhere, but are available in large cities and regional medical centers.

These methods include the following:

• dynamic scintigraphy;
• endoscopic retrograde cholecystopancreatography (ERCP);
• positron emission tomography;
• biopsy.

It is impossible to draw up a diagnostic plan on your own, since only a specialist can assess the need or lack thereof when examining a particular patient.

Detailed description of diagnostics

A detailed description of the method is carried out on the basis of several main criteria. It describes what the work of the technique is based on, what information the doctor will receive with its help, the mechanism for carrying out the manipulation itself.

Blood chemistry

The method is based on the study of the levels of liver enzymes and bilirubin. Diagnosis of the gallbladder involves the study of the level of alkaline phosphatase (AP), gamma-glutamyl transferase (GGT), cholesterol. Increasing the values ​​of the above enzymes and the fraction of direct bilirubin. All indicators or only some can increase. To differentiate liver damage, the activity of alanine aminotransferase (AlT), aspartate aminotransferase (AST) is also examined. The analysis requires blood sampling exclusively from a vein.

Ultrasonography

Now this method is one of the "gold standards" for diagnosing pathologies of the bile ducts, gallbladder and many other diseases. The work is based on the fact that the device generates specific ultrasonic waves that pass through the tissues of the body. Organs with different densities reflect ultrasound waves differently, which makes it possible to visualize the structure of the organ on the monitor, to assess its size and structure. In addition to the structure, the method is able to provide information about the presence of calculi in the gallbladder, assess its tone, size, and function.

The main advantages of the study:

• sufficient information content;
• safety and comfort for the patient;
• no age restrictions;
• speed of execution;
• low price compared to other surveys.

Its disadvantage will be the human factor, since the ultrasound doctor interprets the information from the monitor. Thus, the result directly depends on his qualifications and experience, as well as on the technical characteristics of the equipment.

duodenal sounding

Nowadays, the method is rarely used, since most doctors prescribe an ultrasound. It should be noted that duodenal sounding is forgotten extremely unfairly.

This is a complex manipulation that allows you to qualitatively and quantitatively evaluate all three fractions of bile (A, B, C), determines the level of enzymes in the duodenal content. As a result, it is possible to identify both functional and organic pathology of the biliary tract and gallbladder.

The analysis is performed in the morning on an empty stomach, before which any enzyme medications are canceled for a week.

The patient swallows a gastric tube (preferably a double one) up to the level of 40 cm, in this position the probe advances another ten centimeters, the specialist takes the content. Then the person continues swallowing the probe up to the mark of 70 cm and lies down on the right side, having previously placed a roller under the pelvic ring. A heating pad is necessarily placed under the right hypochondrium for a better outflow of bile. For an hour, the probe advances another twenty centimeters, after which the contents of the duodenum begin to flow into the container. Next, the rest of the bile fractions are collected by introducing special preparations(about an hour more).

The advantages of the method are the following features:

• good information content;
• relative safety for the patient;
• low price.

The main disadvantages will be discomfort for the patient, high requirements for the qualifications of the personnel performing the manipulation, limited use in comorbidities.

X-ray technique

- X-ray method of research, which has also become rarely used since the advent of ultrasound. A contrast agent is injected into the digestive tract. A series of x-rays is taken in real time, which allows you to visualize the organ and evaluate its functional abilities. Due to this, the doctor receives information about the ability of the gallbladder to concentrate bile, its mobility and contractility, and the formation of X-ray positive stones.

The analysis should be carried out after preliminary preparation.

A person drinks a contrast agent, which then enters the bile. Next, the specialist takes a series of pictures after a certain time.

Advantages:

• comfort for the patient;
• sufficient information content;
• adequate price.

The disadvantages of holography include the inability to visualize X-ray negative calculi and the patient receives insignificant radiation.

Dynamic scintigraphy

Cholecsintigraphy is a relatively new technique with which it is possible to examine the gallbladder, identify the pathology of its structure and function, bile ducts, and track the dynamics of bile movement. In addition, the synthetic function of the liver is determined.

The essence of the study is to track the movement of a specific radionuclide, which is administered intravenously. After that, several x-rays are taken. The method is used for diseases of the gastrointestinal tract, requiring more accurate visualization than simple studies give.

Conclusion

You can check the gallbladder with a disease of the hepatobiliary zone by several basic methods. It is important to understand that any study of the gallbladder is performed only after consulting a doctor. The high-quality work of a doctor is impossible without a comprehensive examination of the patient.

gallbladder- an organ of a small size, resembling a bag in shape and located directly under the liver. It stores bile produced by the liver. After eating, it is empty and flat, like a deflated balloon. Before eating, it may be filled with bile and is close in size to a small pear.

In response to signals, stored bile is pushed out by the gallbladder through a series of tubes called ducts into the small intestine. Bile helps digest fats, but the organ itself is not vital. Its removal in an otherwise healthy person usually does not cause observable health or digestive problems, although there may be a small risk of diarrhea and malabsorption of fats.

states

Among the main conditions of the gallbladder can be mentioned cholelithiasis(cholelithiasis), cholecystitis, cancer and gallstone formation in the pancreas.

Gallbladder video

Gallstones - basic concepts

For unknown reasons, substances in bile can crystallize in the gallbladder, forming gallstones. Common and usually harmless, however, they can sometimes cause pain, nausea, or inflammation.

gallstones are crystal-like deposits that develop in the gallbladder. These deposits can be the size of a grain of sand or a golf ball, hard or soft, smooth or uneven. The number of gallstone formations in the gallbladder varies from one to several.

Nearly 10% of men and 20% of women in the US are familiar with gallstones or have had them at some point in their lives, but most of those who have the condition do not realize it. In this case, ignorance probably won't hurt; usually stones that just float inside the gallbladder cause no symptoms and no harm.

These "silent" stones usually go unnoticed unless they show up on an ultrasound done for some other reason. However, the longer the stone exists in the gallbladder, the more likely that it becomes problematic. People with gallstones without symptoms have a 20% chance of having an episode of pain in their lifetime.

Usually, the onset of symptoms is due to the stone shifting and becoming lodged in a bile-carrying duct, such as the cystic duct. This is a small canal that connects to another duct called the common bile duct. Typical symptom- Abdominal pain, possibly accompanied by nausea, indigestion, or fever. Pain caused by contraction of the gallbladder due to a stuck stone usually occurs within an hour after eating a large meal or in the middle of the night. Stones can also block the common bile duct, which carries bile to the small intestine, and the hepatic ducts, which take bile from the liver.

Obstructions in the bile ducts can cause inflammation and possibly infection. Due to blockage of the common bile duct, which drains into small intestine with the pancreatic duct, its inflammation can also occur (cholelithic pancreatitis).

In a rare but dangerous condition that occurs most often in older women, stones migrate into the small intestine and block the passage to the large intestine; symptoms include severe and frequent vomiting. Although gallstones are present in about 80% of people with gallbladder tumors, it is not certain that they play a role except in those with really large (more than 3 cm in diameter) stones.

Approximately one million new cases of gallstones in the gallbladder are diagnosed each year in the United States. For reasons that are still unclear, women are twice as likely to be bothered by them as men. In the US, Native Americans have the highest rates of gallstone formation because they are genetically predisposed to secrete high levels of cholesterol in bile (a factor that contributes to their formation in the gallbladder). This problem is also quite common among Mexican Americans.

In addition, gallstones are common in people over the age of 60, those who are obese or have lost a lot of weight in a short period of time, those with diabetes, and women who have had multiple pregnancies and who taking hormone replacement therapy or birth control pills.

The gallbladder is primarily designed to store bile, a brown or yellowish color with which the body breaks down fatty foods. When eating, bile stored in the gallbladder is released into the cystic duct. From there, the liquid, passing through the common bile duct, mixes with food in the small intestine.

The main ingredients of bile are bile acids and cholesterol. Usually the concentration bile acids high enough to break down the cholesterol in the mixture and keep it in liquid form. However, a diet high in fat can upset this delicate balance, causing the liver to produce more cholesterol than the bile acids can handle. As a result, some of this excess cholesterol begins to harden into crystals, which we call gallstones. Almost 80% of all gallstones appear in this way and are called cholesterol. The remaining 20% ​​is composed of calcium mixed with the bile pigment bilirubin and are called pigment stones.

Even eating right, you can encounter gallstone formations in the gallbladder. Researchers have found that an extremely low-fat diet may also contribute to the formation of gallstones. If the gallbladder has to digest a little fatty food, it gets into the game less often than usual, so the cholesterol has more time to harden. Other potentially reducing factors include reduced activity in the gallbladder leading to gallstone formation, cirrhosis of the liver, birth control pills, hormone replacement therapy, and pregnancy.

family predisposition, diabetes mellitus, sudden loss weight, cholesterol medications, and older age can also increase the risk of gallstones.

Cholecystitis

Cholecystitis called inflammation of the gallbladder. Normally, a fluid called bile flows from it into the small intestine. If its flow is blocked, it accumulates inside the gallbladder, resulting in swelling, pain, and possible infection.

The most common cause of sudden (acute) cholecystitis is a gallstone stuck in the cystic duct, the channel that carries bile from the gallbladder. The gallstone blocks the flow of fluid from the gallbladder. As a result, irritation and swelling occurs. In addition, cholecystitis can be caused by infection or injury, such as from a car accident.

Acute acalculous cholecystitis, although rare cases, most commonly seen in seriously ill people in hospital intensive care units. In these cases, there are no stones in the gallbladder. Complications from another serious illness, such as HIV or diabetes, cause swelling.

Another form of cholecystitis is long-term (chronic) cholecystitis. It occurs when swelling of the gallbladder persists over time, causing its walls to thicken and harden.

Upper right abdominal pain is the most common symptom of cholecystitis. Sometimes it can move along the back or to the right shoulder blade. Other signs include:

• nausea or vomiting;
• Tenderness at the top of the abdomen;
• Fever;
• Pain that worsens with deep breathing;
• Pain for more than 6 hours, especially after eating.

For older people, they may not have fever or pain. Their only symptom may be an area of ​​tenderness in the abdomen.

Diagnosis and treatment of cholecystitis

Making a diagnosis begins with describing the symptoms to the doctor. Next comes the medical examination. The doctor carefully feels the right upper part of your abdomen, localizing the sensitivity. You may need to have a blood test and an ultrasound of the gallbladder, an examination that uses sound waves to create a picture of the organ. With the help of ultrasound, you can see stones in the gallbladder, thickening of its wall, excess liquid and other signs of cholecystitis. With this test, doctors can also check the size and shape of the gallbladder.

In addition, you can also have a gallbladder scan, a nuclear scanning procedure that checks how well the gallbladder is functioning. It can also help detect blockages in the channels (bile ducts) leading to the gallbladder and small intestine (duodenum) from the liver.

How cholecystitis is treated will depend on your symptoms and overall health. If there are gallstones in the gallbladder but no symptoms, treatment may not be needed. In mild cases, treatment includes bowel rest, fluids, intravenous antibiotics, and pain medication.

Typically, the treatment for acute cholecystitis is an operation in which the gallbladder is removed (cholecystectomy). Often the operation can be done through small incisions in the abdomen (laparoscopic cholecystectomy), but sometimes a more extensive operation is required. Your doctor may attempt to reduce swelling and irritation in your gallbladder before it is removed. Acute cholecystitis sometimes caused by one or more gallstones stuck in the main duct leading to the intestines (common bile duct). Treatment may include an endoscopic procedure (endoscopic retrograde cholangiopancreatography or ERCP) to remove common bile duct stones before the gallbladder is removed.

Rarely, with chronic cholecystitis, you may also be prescribed a medicine that dissolves gallstones in the gallbladder over a period of time.

gallbladder cancer

gallbladder cancer- a rare phenomenon, but it can affect this organ. In this disease, malignant (cancer) cells form in the tissues of the gallbladder. It is difficult to diagnose and is usually discovered after the onset of symptoms. The symptoms may resemble those of gallstones.

With regard to the anatomy of the gallbladder, its wall consists of three main layers of tissue:

• Serous (external);
• Muscular (medium);
• Mucous (internal).

Between them is a supporting connective tissue. emerging in inner layer primary cancer spreads through the outer layers as it grows.

In women, as a rule, the risk of developing cancer of the gallbladder is higher.

Among the risk factors, that is, what increases your chances of getting gallbladder cancer:

• Belonging to the female gender;
• Belonging to the indigenous population of America.

In addition, possible signs of gallbladder cancer include jaundice, pain, and fever.

This problem may be accompanied by these and other symptoms. However, other conditions can also cause the same symptoms. Consultation with a doctor is required if you have any of the following problems:

• Pain in the area above the stomach;
• Bloating
• Jaundice (yellowing of the skin and whites of the eyes);
• Fever;
• Nausea and vomiting;
• Lumps in the stomach.

Gallbladder cancer at an early stage is difficult to detect and diagnose for the following reasons:

• The gallbladder is hidden behind the liver.
• Absence of any noticeable signs or symptoms in the early stages;
• The symptoms, when present, are similar to those of many other problems.

It happens that cancer occurs if the gallbladder was removed for other reasons. It rarely develops in patients with gallstones.

Tests that look at the gallbladder and nearby organs are used to detect, diagnose, and stage this type of cancer. They can also show how far it has spread. The process of learning about the spread of cancer cells in and around the gallbladder is called staging.

To plan treatment, it is important to know if the tumor is suitable for surgical removal. It is common practice to run tests and procedures at the same time to detect, diagnose, and stage gallbladder cancer. For this, the following tests and procedures are used:

• Examination and medical history: the patient's body is examined for signs of disease, such as bumps or anything else that seems unusual, and to check common features health. A history of the patient's health habits will also be compiled, past illnesses and treatment.
• Ultrasound examination: a procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs, creating an echo. Through these signals, a picture of the tissues in the body, called a sonogram, is created. One of the diagnostic methods for a tumor of the gallbladder is an ultrasound of the abdominal cavity.
• Liver tests: a procedure in which a blood sample is tested to measure the amount certain substances released into the blood by the liver. A sign of liver disease, which potentially stimulates gallbladder cancer, may be the amount of the substance is greater than usual.
• Analysis for antigen CA 19-9: This test measures blood levels of this cancer antigen. CA 19-9 is released into the bloodstream from cancer cells and normal cells. If its elevated content is found, this may indicate gallbladder cancer or other conditions.
• Analysis for carcinoembryonic antigen (CEA): This test measures the level of CEA in the blood. The antigen is released into the bloodstream from cancer and normal cells. If its elevated content is found, this may indicate gallbladder cancer or other conditions.
• CT (computed tomography): In this procedure, a series of detailed pictures of the inside of the body are taken from different angles. The photographs are taken using a computer connected to an x-ray machine. To make it possible to more clearly see the organs, a dye is used, which is injected into a vein or swallowed.
• Blood chemistry: In this procedure, a blood sample is tested to measure the amount of certain substances that enter it from organs and tissues in the body. An unusual (lower or higher than normal) content of a substance may indicate disease in the organ or tissue where it is produced.
• x-ray: Organs and bones within a given area are studied. X-ray is a kind of energy beam that can pass through the human body and onto a special film, creating a picture of the internal organs.
• MRI (magnetic resonance imaging): This procedure uses a magnet, radio waves and a computer to take detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). To make the channels (ducts) that carry bile from the liver to the gallbladder and from it to the small intestine better displayed on the image, a dye can be injected into its area. This procedure is called MRCP (magnetic resonance cholangiopancreatography). A dye is injected into a vein to create detailed pictures of the blood vessels around the gallbladder. This procedure is called MRA (magnetic resonance angiography).
• ERCP(endoscopic retrograde cholangiopancreatography): This is an x-ray examination of the ducts that carry bile from the liver to the gallbladder and from there to the small intestine. It happens that these channels are narrowed due to gallbladder cancer, thereby blocking or slowing down the flow of bile, causing jaundice. Then, an endoscope (thin tube) is passed through the mouth, esophagus and stomach into the first part of the small intestine. After that, a catheter (a tube of a smaller diameter) is inserted into the bile ducts through the endoscope. A dye is injected through the catheter into the ducts and an x-ray is taken. If the ducts are blocked by a tumor, a thin tube may be inserted into the duct to unblock it. This tube (or stent) can be left to open the canal. In addition, tissue samples may be taken.
• Biopsy: Obtaining tissue samples so that a pathologist can examine them under a microscope for signs of a tumor. A biopsy can be done after surgery to remove the tumor. There is a chance that the tumor obviously cannot be removed surgically, in which case a biopsy can be done with a fine needle to remove cells from the tumor.
• Laparoscopy: In this surgical procedure, organs inside the abdomen are examined to check for signs of disease. Small incisions are made in the abdominal wall, and a laparoscope (thin tube) is inserted into one of them. They can be used to insert other instruments to perform procedures such as organ removal or tissue sampling for biopsy. The procedure helps determine if the cancer is within the gallbladder or has spread to nearby tissues and whether it needs to be surgically removed.
• PTCG (percutaneous transhepatic cholangiography) In this procedure, an X-ray of the liver and bile ducts is taken. A thin needle is inserted into the liver through the skin under the ribs. A dye is injected into the liver or bile ducts and an x-ray is taken. If a blockage is found, sometimes a thin, flexible tube called a stent is inserted into the liver to drain the bile into the small intestine or collection container outside the body.

Certain factors affect prognosis (chance of recovery) and treatment options:

• The stage of the cancer (whether it has spread to other places from the gallbladder);
• Is it possible to remove the cancer completely by surgery;
• Type of cancer (how cancer cells look under a microscope)
• Whether the cancer has just been diagnosed or has recurred (relapsed).

In addition, treatment may depend on the age and general health of the patient and whether the cancer is causing symptoms.

The problem can only be dealt with if the cancer is found before it spreads, when it can still be removed with surgery. If the cancer has spread, the patient's quality of life can be improved by palliative care by controlling the symptoms and complications of this disease.

pancreatitis

There are two types pancreatitis, chronic and acute. Both are inflammation of the pancreas, which produces digestive enzymes used by the body to metabolize carbohydrates and fats into the hormone insulin.

The symptoms of acute pancreatitis are usually severe and need to be treated. Left untreated, pancreatic cysts, abscesses, and leaks of pancreatic fluid into the abdomen can develop, which can lead to other long-term problems or even death. Shock is a possible fatal complication of acute pancreatitis.

The development of chronic pancreatitis occurs over a number of years, usually after a history of recurring attacks of acute pancreatitis. Due to chronic pancreatitis, there may be a loss of the ability to secrete enzymes that the body needs to digest food. As a result, a condition known as pancreatic insufficiency develops, which is the main characteristic of chronic pancreatitis, and the signal is weight loss, gradual or sudden, as well as foul-smelling stools or diarrhea. Chronic pancreatitis can also lead to diabetes mellitus and pancreatic calcification, in which small, hard deposits of calcium develop in the pancreas.

Nearly 80% of all cases in the US of acute pancreatitis are associated with excessive alcohol consumption and gallstones. The remaining cases are the result of viral and bacterial infections, drugs, blockage of the pancreatic duct, trauma or surgery in the abdomen, elevated calcium levels, or extremely high levels triglycerides (a type of fat that circulates in the blood).

These factors seem to encourage pancreatic digestive enzymes to act on the pancreas itself, causing it to swell, bleed, and damage blood vessels. Slightly less than half of the people who develop chronic pancreatitis are alcoholics; Alcohol abuse is the most common cause of pancreatic insufficiency in adults. The main reason that children experience sweat is cystic fibrosis. Heredity may also play a role in pancreatitis.

Gallbladder Tests

The most effective tests in diagnosing gallbladder problems are such tests as abdominal ultrasound, nuclear scan, uhendoscopic retrograde cholangiopancreatography, mmagnetic resonance cholangiopancreatography, eendoscopic ultrasound andabdominal x-ray.

abdominal ultrasound

abdominal ultrasound is a non-invasive type of examination in which a transducer on the skin reflects high-frequency sound waves from structures in the abdomen. Ultrasound is an excellent test for detecting gallstones and checking the walls of the gallbladder. The reflected sound waves in this analysis help create pictures of the organs and other structures in the upper abdomen. In some cases order special kind Ultrasound for a detailed assessment of a specific organ, such as kidneys, liver, spleen, pancreas. With regard to the gallbladder, this type of test is used to look for gallstones, inflammation of the organ (cholecystitis) or blockage of the bile ducts, and to look for problems with the pancreas, such as tumors.

Tell your doctor if you have had a barium enema or have had GI tests in the past 2 days. Barium remaining in the intestines can interfere with the ultrasound.

To have an ultrasound of your liver, gallbladder, spleen, and pancreas, you may be asked to eat a low-fat meal the evening before the test and then not eat for 8 to 12 hours before the test.

The analysis is done by a doctor who specializes in conducting and interpreting imaging examinations (radiologist) or by an ultrasound technologist (sonographer) supervised by a radiologist. The procedure is performed in an ultrasound room in a hospital or doctor's office.

All jewelry that might interfere with the ultrasound should be removed. In addition, you will have to remove all or most of your clothing, depending on the area being examined. Underwear will be allowed if it does not interfere with the analysis. You will be given cloth or paper to cover yourself.

You will lie on a padded table on your back or on your side. To improve the quality of the sound waves, a heated gel is spread over the skin of the abdominal cavity. A transducer (a small hand-held device) is pressed against the abdomen and moved back and forth. Organs and blood vessels are displayed on the video monitor.

You may be asked to change position to take more pictures. During the examination, you will have to remain still. You may be asked to hold your breath for a few seconds during the scan. This will allow the sonographer to see organs and structures such as the bile ducts more clearly because they do not move. Holding the breath also temporarily shifts the liver and spleen down in the abdomen so that they do not cover the lower ribs, making them harder for the sonographer to distinguish.

Usually, an abdominal ultrasound takes 30-60 minutes. You may be asked to wait while the radiologist reviews the information. The radiologist may decide to take more pictures of certain areas of your abdomen.

If the gel is not warmed to body temperature first, it may feel cold. You will feel a slight pressure as the transducer passes through your abdomen. But if the examination is done to check for damage from a recent injury, light pressure on the transducer may be slightly painful. Sound waves cannot be felt or heard.

The risks of abdominal ultrasound are not known.

The reflected sound waves in this type of ultrasound help to obtain images of organs and other structures in the abdominal cavity.

Speaking about the normal results of an ultrasound of the gallbladder, this is the normal thickness of its wall, the normal size of the ducts between it and the small intestine, as well as the absence of gallstones. A deviation from the norm is a thickening of the walls, the presence of fluid around this organ, which may indicate inflammation. The bile ducts may be enlarged due to a blockage (a stone or an abnormal growth in the pancreas). Gallstones in the gallbladder may be visible.

• stool, air (or other gas), or contrast material (such as barium) in the stomach or intestines;
• Inability to remain still during the examination;
• excessive obesity;
• The presence of an open or bandaged wound in the area being examined.

• Tingling in the mouth, especially when there are dental fillings with metal in the mouth.
• Heat in the study area. This is fine. Tell the technologist if you experience headache, dizziness, nausea, vomiting, burning, pain, or trouble breathing.

There are no known harmful effects from the strong magnetic field used for MRI. But given the high power of the magnet, it may affect pacemakers, artificial limbs, and other medical devices that contain iron. Clocks near it will be stopped by a magnet. There is a risk of damage to any loose metal object if it is attracted to a strong magnet.

Metal parts in the eyes can damage the retina. If you may have metal fragments in your eyes, an x-ray of your eye may be taken before the MRI. When metal is found, an MRI is not done.

Iron pigments in a tattoo or tattooed eyeliner can cause skin or eye irritation.

Burns may occur at the site of some medicinal patches due to MRI. If you are wearing a patch, be sure to tell your doctor.

You should not forget about the small risk of an allergic reaction when using a contrast agent during an MRI. But in most cases, the reactions are mild and can be treated with medication. In addition, there is a small risk of infection at the intravenous site.

Immediately after the MRI, you can discuss the first results with your doctor. It usually takes 1-2 days for your doctor to get full results.

An MRI can sometimes find a problem in a tissue or organ, even if the tissue or organ is of normal size and shape.

When examining the gallbladder normal result MRI is the absence of abnormal growths, such as tumors, as well as signs of inflammation or infection.

An abnormal result is blockage of the bile ducts.

Some of the reasons why you won't be able to take the test or why the results are useless include:

• Pregnancy. An MRI is not usually done during pregnancy. But it can be done to get more information about a possible problem that may not be seen well on an ultrasound.
• Medical devices with electronic components, such as pacemakers or drug infusion pumps. The MRI magnet can cause problems with these devices, which can prevent you from getting the exam.
• Medical devices with metal. Metal can blur MRI images. As a result, it will prevent the doctor from seeing the organ. For example, intrauterine device(IUD) with metal can make it difficult to see the uterus clearly.
• Inability to remain still during analysis.
• Obesity. An overweight person may not fit into standard MRI machines.

Many modern medical devices that do not use electronics, such as heart valves, stents, or clamps, can be safely placed in most MRI machines. But some new machines use stronger magnets. The safety of MRI machines with these more powerful magnets for people with medical devices is not known.

It is possible to get MRI results that are different from CT scans, ultrasounds, tests, and x-rays because tissue is displayed differently in MRI.

An MRI is a safe test for viewing structures and organs inside the body. It costs more than other methods and is not available everywhere.

In open MRI machines, the magnet does not completely surround you. But these machines may not be available in all medical centers. An open MRI is useful for people who are claustrophobic or obese.

An MRI can be used to check different parts of the body, such as the head, abdomen, chest, back, shoulder, and knee.

Magnetic resonance angiography (MRA) is a special method of MRI of blood vessels and blood flow.

Spectroscopic MRI is a special method that determines certain medical problems when searching for certain chemicals in body tissues.

Contrast material containing gadolinium can cause a serious skin problem (nephrogenic fibrosing dermopathy) in people with kidney failure. Tell your doctor before an MRI if you have a serious kidney disease or have had kidney transplants.

Endoscopic ultrasound

Endoscopic ultrasound(EUS) is a procedure that allows the doctor to obtain images and information about digestive tract and surrounding tissues and organs. An ultrasound uses sound waves to create pictures of internal organs.

During the procedure, a small ultrasound device is placed on the tip of the endoscope. An endoscope is a small, flexible tube with a light attached to a camera. By inserting an endoscope and a camera into the upper or lower digestive tract, the doctor is able to obtain good ultrasound images of the organs. Because EUS can get close to the organs in question, the images it produces are often more accurate and detailed than the images provided by traditional ultrasound, which must come from outside the body.

Endoscopic ultrasound can be used to:

• Cancer Staging Estimates
• Assessments for chronic pancreatitis or other pancreatic disorders.
• Study of abnormalities or tumors in organs, including the gallbladder and liver.
• Examination of the muscles of the lower rectum and anal canal to determine the causes of fecal incontinence.
• The study of nodes (cones) in the intestinal wall.

The person undergoing an endoscopic ultrasound will be given a sedative before the procedure. The doctor then inserts the endoscope into the person's mouth or rectum. The doctor will observe inner part gastrointestinal tract on a TV screen and an ultrasound image on another monitor. In addition to examination, sound waves can be used to detect and assist in biopsy (taking a small piece of tissue for examination under a microscope). The entire procedure usually takes 30 to 90 minutes and the patient can usually go home the same day.

Abdominal x-ray

Although it can be used to look for other problems in the abdomen, x-rays usually cannot diagnose gallbladder disease. At the same time, it can be used to detect stones in the gallbladder.

Abdominal x-ray gives a picture of the structures and organs in the abdomen. These include the stomach, liver, spleen, large and small intestines, and the diaphragm, the muscle that separates the chest and abdomen regions. Often two shots are taken from different positions.

X-rays are a form of radiation, like light or radio waves, that are concentrated into a beam like the beam from a flashlight. X-rays are able to penetrate most objects, including the human body. When rays fall on photographic film, a picture is obtained. Bones, being dense tissues, absorb (block) many X-rays, as a result, we see these areas in white on an X-ray. Less dense muscles and organs block less x-rays and appear as shades of gray on x-rays. Passing mainly through the air, for example, through the lungs, x-rays appear black in the picture.

An abdominal x-ray may be one of the first tests to look for the cause of abdominal pain, bloating, nausea, or vomiting. More specific problems can be searched for with other tests (eg, ultrasound, CT, or intravenous pyelography).

This survey is for:

• Looking for the cause of pain or swelling in the abdomen or persistent nausea and vomiting.
• Looking for the cause of pain in the lower back on either side of the spine (flank pain). It can show the size, shape, and position of the liver, spleen, and kidneys.
• Looking for stones in the gallbladder, kidneys, ureters, or bladder.
• Seeking air outside the intestines (intestine).
• Looking for an object that has been swallowed or placed in a body cavity.
• Confirmation of the correct position of the drainage tubes or catheters.

You may need to sign a consent form before the examination begins. Talk to your doctor about any concerns you have about the need for the test, its risks, how it is done, and the meaning of the results.

Before the x-ray, tell your doctor if you:

• Pregnant or suspect it. Generally, pregnancy does not allow for an abdominal x-ray due to the risk of radiation exposure to your baby (fetus). In many cases, the area is examined by ultrasound instead.
• Have had an x-ray using barium-based contrast (eg, barium enema) or taken a drug (eg, pepto-bismol) containing bismuth within the last 4 days. Barium and bismuth can block a clear picture.

Before the test, you may be asked to empty your bladder. You may need to remove any jewelry that may be in the way of the x-ray image, for example if you have a navel piercing.

An x-ray of the abdomen is performed by a radiology technologist. Some other doctors, such as emergency room doctors, may also look at an abdominal x-ray to check for common problems, such as a blocked bowel.

You may need to remove all or most of your clothing. You will be given a gown during the test.

You will lie on your back on a table. The lower pelvis may be covered with a lead apron to protect it from x-rays. During this examination, the woman's ovaries cannot be protected because they lie too close to the examined organs. A man's testicles can sometimes be protected during the test.

When the x-ray machine is over your abdomen, you will be asked to hold your breath while the pictures are taken. You need to lie still for the picture to be clear.

In many cases, two pictures are taken: one in the supine position (on the back) and the other in the standing position (vertical view). The latter can help find a blockage in the intestines or a hole (perforation) in the stomach or intestines through which air is leaking. If you are unable to stand, an x-ray may be taken lying on your side with your arm above your head.

An abdominal x-ray takes about 5 to 10 minutes. While the pictures are being processed, you will be asked to wait about 5 minutes. In some clinics and hospitals, X-ray images can be displayed directly on a computer screen (in digital form).

You will not feel any discomfort from the x-ray. The table may feel hard and the room may be cool. The position you have to maintain may feel awkward or painful, especially if you've been injured.

There is always a small chance of cell or tissue damage from radiation, including the low levels used for this study. But the chance of x-ray damage is generally very low compared to the benefits of the test.

Fluoroscopy gives a picture of the structures and organs in the abdomen. In an emergency, the results are ready in a few minutes. Otherwise, they will be ready in 1-2 days.

In some cases, gallstones can be seen on x-rays.

Some of the reasons why you won't be able to take the test or why the results are useless include:

• Pregnancy. If a view of the pregnant woman's abdomen is needed, an ultrasound may be done instead.
• Recent tests using barium or bismuth. These substances show up on x-ray films and block a clear picture.
• Inability to lie still and hold one's breath during the test.

The results may differ from previous test results because you were examined at a different medical center or you had a different type of test.

Some results on an abdominal x-ray may mean more tests are needed to find the cause of the problem. These tests may include endoscopy, ultrasound, computed tomography (CT), barium enema, or intravenous pyelography.

Abdominal x-rays cannot detect certain problems, such as bleeding stomach ulcers.

At the same time, a chest x-ray can be done.

In the event of an emergency, or if the person is physically unable to go to a hospital or clinic's x-ray department, portable x-ray equipment may be used. But pictures from stationary X-ray equipment are usually better than those from portable counterparts.

Methods of treatment of the gallbladder

Among the main medical techniques for gallbladder problems, removal of this organ, drug treatment, chemotherapy and radiation therapy.

Cholecystectomy

In this operation, the gallbladder is removed by the surgeon through laparoscopy (several small incisions) or laparotomy (traditional "open" surgery with a large incision).

Laparoscopic surgery

In laparoscopic surgery cholecystectomy) The gallbladder and gallstones are removed through several small incisions in the abdomen. The surgeon inflates the abdomen with air or carbon dioxide to see clearly.

The surgeon inserts a probe with a light attached to a video camera (laparoscope) into one incision near the navel. He then uses a video monitor to guide him as he inserts surgical instruments into other incisions to remove the gallbladder.

Before the surgeon removes your gallbladder, you may have a special x-ray procedure called a cholangiogram on the operating table that shows the anatomy of the bile ducts.

You will need general anesthesia for this operation, which usually takes 2 hours or less.

After surgery, bile flows from the liver (where it is made) through the common bile duct and into the small intestine. Because the gallbladder has been removed, the body can no longer store bile between meals. For most people, it has little or no effect on digestion.

In 5-10 out of 100 laparoscopic procedures of this kind in the US, the surgeon must move to an open surgical method which requires a larger incision. Examples of problems that may require open rather than laparoscopic surgery include unexpected inflammation, scar tissue, injury, or bleeding.

The operation may take place in outpatient settings or you can stay 1 or 2 days in the hospital.

In most cases, you can return to your normal activities in 7-10 days. In humans, after laparoscopic gallbladder surgery, pain lasts about a week. But after 2-3 weeks, they have much less discomfort than people after open surgery. After the operation, you do not need to comply special diet or other precautions.

Laparoscopic surgery is best practice treating gallstones that are causing symptoms, unless there is reason that surgery should not be done.

Laparoscopic surgery is used most often when there are no potentially complicating factors present.

It is safe and effective and gets rid of stones located in the gallbladder. It does not remove stones in the common bile duct. Gallstones may appear in the common bile duct years after gallbladder removal, although rarely.

The overall risk of laparoscopic surgery is very low. The most serious possible complications include:

• Incision infection.
• Internal bleeding.
• Damage to the common bile duct.
• Injury to the small intestine by one of the instruments used during surgery.
• Risks of general anesthesia.
• Other unusual complications may include:
• Damage to the cystic duct, which carries bile from the gallbladder into the common bile duct.
• Gallstones remaining in the abdomen.
• Bile leaking into the abdominal cavity.
• Injury to blood vessels in the abdomen, such as the large blood vessel that carries blood from the heart to the liver (hepatic artery). Occurs on rare occasions.
• Gallstone pushed into the common bile duct.
• Liver cut.

Additional surgical procedures may be needed to correct complications.

Some people continue to have symptoms in their abdomen after surgery, such as pain, bloating, gas, and diarrhea (postcholecystectomy syndrome).

Recovery after laparoscopic surgery is faster and less painful compared to open surgery.

After laparoscopic surgery, the length of stay in the hospital is shorter than after open surgery. As a rule, you can go home the same day or the next day, compared to 2-4 days or more in the case of open surgery.

Recovery is faster after laparoscopic surgery.

You will spend less time away from work and other activities after laparoscopic surgery (7-10 days compared to 4-6 weeks).

Antibiotics

Antibiotics are drugs that kill bacteria. But they only work against bacteria. They don't kill viruses, so they won't work against a cold, flu, or other viral illness. Unless you have a bacterial infection, it is best to avoid the possible harmful effects of antibiotics, potentially including:

• Side effects. Antibiotics can cause nausea and diarrhea and increase sensitivity to sunlight. Most of these common side effects are mild. But several side effects such as allergic reactions can be very serious. They can cause shortness of breath or even death. Tell your doctor if you have an unexpected reaction to an antibiotic.
• other infections. Antibiotics kill most bacteria in the body that are sensitive to them, even the "good" bacteria that help your body. Antibiotics can disrupt the balance of bacteria in the body, leading to indigestion, diarrhea, vaginal infections, or other problems.
• Bacterial resistance. If you take antibiotics when you don't need them, they may not work when you need them. Any time you take antibiotics, you likely have some bacteria that the medicine doesn't kill. Over time, these bacteria change and are harder to kill. They become drug resistant. The antibiotics used to kill them no longer work.

If you and your doctor decide that you need an antibiotic, carefully follow the instructions for taking it.

Take the entire dose for as many days as your doctor tells you to, unless you have unanticipated side effects (in which case contact your doctor).

Make sure you are aware of any special instructions for taking the medicine. They should be printed on the label, but it's also a good idea to check with your doctor and pharmacist.

Store antibiotics in a cool, dry place. Check the label to see if you should store them in the refrigerator.

Never give an antibiotic prescribed for one person to someone else.

Do not store any additional antibiotics. And don't use one that was prescribed for another illness unless your doctor says it's appropriate. Ask your pharmacist if it's safe to throw away leftover medication.

Chemotherapy and Radiation Therapy

After surgery for gallbladder cancer, chemotherapy and radiation therapy may be used to help prevent the cancer from returning.

Treatment for localized cancer may include:

• An operation to remove the gallbladder and part of the tissue around it. Part of the liver and nearby lymph nodes may also be removed. Radiation therapy with or without chemotherapy may follow surgery.
• Radiation therapy with or without chemotherapy.

Treatment of inoperable, recurrent, or metastatic cancer is usually done through clinical trials. Treatment may include:

• Percutaneous transhepatic bile drainage or placement of stents to relieve symptoms caused by blocked bile ducts. This may be followed by radiation therapy as a palliative treatment.
• Operation as a palliative treatment to relieve symptoms caused by blocked bile ducts.
• Chemotherapy.
• Clinical study of new ways to provide palliative care radiotherapy such as combination with hyperthermia therapy, radiosensitizers or chemotherapy.
• Clinical trial of new drugs and drug combinations.

Ursodeoxycholic acid

For people who have problems with gallstones and are not good candidates for surgery, this oral medication is an option. Ursodeoxycholic acid may help dissolve small cholesterol gallstones in the gallbladder and reduce symptoms. Another oral solution is called Henix.

Generic Name: Ursodiol

Brand Name: Actigall

Bile acids slowly dissolve cholesterol gallstones. The tablets are taken daily for up to 2 years.

The medicine is sometimes used in a small group of people for whom the risks of surgery are too high.

Bile acids can also be used to help prevent the formation of gallstones during rapid weight loss. And they can be used after lithotripsy (extracorporeal shock wave treatment) to help dissolve gallstone fragments more quickly.

Ursodiol dissolves gallstones over several months. And since the organ itself is not removed, the stones often return.

All medicines have side effects. But it happens that some people do not have them, while others face them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with the medicine.

Usually, the benefits of a drug outweigh any minor side effects.

It is likely that side effects will disappear for some period after taking the medicine.

If the side effects are still bothering you and you are wondering if you should continue taking the medicine, contact your doctor. He can lower the dose or change the medicine. Do not suddenly stop taking the drug, unless your doctor tells you to.

Call an ambulance immediately if:

• Difficulty breathing;
• Urticaria;
• Swelling of the face, lips, tongue, or throat.

The most common side effects of this medication include:

• Constipation or diarrhea.
• Headache.
• Spasms of the stomach.
• Nausea.

Medicine is one of the many tools a doctor has to treat a health problem. Taking the medicine as suggested by your doctor will improve your health and may prevent problems in the future. If you don't take your medicines correctly, you could endanger your health (and possibly your life).

There are many reasons why people have problems while taking medication. But in most cases, there is always something you can do.

Advice for women

If you are pregnant, breastfeeding, or planning to become pregnant, you should not use any medication without a doctor's recommendation. Some medications can harm your baby. These include prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure all your doctors know if you are pregnant, breastfeeding, or planning to become pregnant.

Follow-up examination is a key element of treatment and safety. Be sure to make an appointment and come to an appointment, and call your doctor if you have any problems. In addition, it would be nice to know the results of examinations and keep a list of medications taken.

Extracorporeal shock wave lithotripsy

High-energy shock waves are projected from the machine through the abdominal wall, breaking up gallstones. The crushing method works best if there are only a few small stones in the gallbladder.

Other treatments

Other widely available options for the treatment of gallstones are not yet known. In addition, there is little data on their effectiveness and long-term impact compared to surgery.

Other treatments for gallstones include:

• Lithotripsy. This procedure uses ultrasonic waves to break up gallstones. It is possible to use it alone or together with bile acids to break up stones. The procedure, rarely used today, was used for people who were not strong enough to operate with long-term (chronic) inflammation of the gallbladder (cholecystitis). But it is not suitable for the treatment of sudden (acute) cholecystitis.
• contact solution therapy. This method uses a thin, flexible tube (catheter) through which a chemical is injected into the gallbladder to dissolve the gallstones. Due to the risk of complications, this therapy is rarely used. And unlike the operation, in this case, the stones can return.
• Percutaneous cholecystostomy. This procedure may provide temporary relief in cases of gallbladder inflammation prior to endoscopic retrograde cholangiopancreatogram (ERCP) or surgery. During a percutaneous cholecystostomy, the doctor will insert a tube through the abdomen and into the gallbladder to drain its contents. This is sometimes done for people who are not strong enough for surgery.

Why is it important to do it as soon as possible?

Stagnation of bile, otherwise this condition is called cholestasis and it is associated with a very common disorder - biliary dyskinesia. Many people learn about it after they go to ultrasound diagnostics, but in real life, as a rule, they do nothing. And very in vain! Read why this banal diagnosis can really ruin your life if you don't take very simple measures...

So, any stagnant processes in the body negatively affect your health. This is especially important with regard to chronic stagnation bile, because if it is light, freely excreted with food into the duodenum, then your digestion is normal and toxins are removed from the body in time.

If this is not the case, bile stagnates in the gallbladder, which means - expect illness: first of all, digestive disorders, symptoms of intoxication from the nervous system - chronic fatigue, and skin manifestations in the form of age spots, itching, allergies and decreased immunity.

The ancient physicians also noticed that a “bilious” person is always irritable and overtired. Why? All because of the same chronic intoxication, excessive intake of neurotoxins into the blood, primarily bilirubin.

In this article, you will find practical recipes, based on over 20 years of experience using only natural and safe remedies, on how to eliminate the causes of bile stasis in the gallbladder and improve your digestion and overall health.

The solution to this problem gives a set of measures - support for the functioning of the liver, nervous system and reasonable nutrition.. No need to despair when you find out about problems in the gallbladder. If you are engaged in the prevention of complications, conduct cleansing courses for the gastrointestinal tract, change your diet a little, then serious problems can be avoided.

And for those who have already had to undergo gallbladder surgery, our recommendations will also help to avoid other serious problems. The main thing is not to continue living without paying attention to your body, but to show a little care towards it.

How to understand that you have bile stasis

Of course, you can contact a gastroenterologist and do tests:

• Blood chemistry(revealed hyperbilirubinemia, hyperlipidemia, excess activity of the enzymes transaminase ALT, ACT and alkaline phosphatase).
• Analysis of urine allows you to see the presence of bile pigments in it.
• Ultrasound examination of the liver allows you to confirm an increase in its size, a change in the shape and condition of the gallbladder wall and the tone and patency of the ducts.

The problem is that, for example, in Europe, the United States, the doctor is in no hurry to prescribe examinations with clear complaints.

Therefore, most readers of this article will focus more on their own feelings.

The first thing you feel is: heaviness and discomfort in the area of ​​the right hypochondrium, bitterness in the mouth, a yellow or brown coating appears on the tongue, the stool is disturbed - more often the alternation of disorder and constipation. The liver may not bother you much, but there will be signs on the skin - know that dark spots, which more and more is not the norm, as well as incomprehensible itching of the skin, active growth of papillomas. These are body signals that the liver cannot cope with intoxication and the gallbladder cannot cope with the load.

One of the specific symptoms is cystitis after the abuse of fat and alcohol.. No gastroenterologist would connect this condition with biliary stasis, but a Chinese medicine specialist would easily explain that the connection is direct - both bladders remove detoxification by-products, and when bile begins to secrete intensely during the "holidays", it translates water-soluble irritants into the blood substances - bilirubin, which disturbs the bladder and provokes cystitis.

Pain in the region of the liver is a more serious sign than heaviness in the right side. She can talk about the presence of stones already, and not just sediment and bile clots, as well as yellowness of the sclera and skin - they require a visit to a doctor, because they can talk about incomplete patency of the biliary tract.

Remember that gallstones do not grow in a month, likewise, an increase in the liver and fatty hepatosis and atherosclerosis do not occur in a couple of weeks. This is the result of inattention to biliary stagnation and impaired functioning of the liver cells for months and years.. But, if you patiently and regularly conduct natural cleansing courses, safe means, then the body will respond to your concern for its needs and the recovery process will proceed more and more intensively. We wish you good health and longevity!

How bile stasis develops in the gallbladder

The most common causes of cholestasis are as follows:

1. The shape of the gallbladder may have changed: it is pear-shaped, there is a deformation of the gallbladder, such as its constriction, bending of the neck, twisting and others. It happens from birth or the way of life works.

2. The effect on the tone of the biliary tract is exerted by stress, neurosis, the state of the autonomic nervous system.

There are two forms of dyskinesia- violations of the promotion of bile due to smooth muscle tone: hypertonic, or hyperkinetic (increased tone of the gallbladder); hypotonic ( low tone gallbladder).

These variants of dyskinesia are often combined with hypertension or hypotension of the biliary tract sphincters and the sphincter of Oddi - at the exit of the common bile duct into the duodenum.

3. The tone of the gallbladder is also affected by disruptions in the level of thyroid hormones: hypothyroidism causes lethargy, and hyperthyroidism causes spasms.

4. The amount of plant fibers in food is also the basis for the normal functioning of the bile, but if the food is mostly meat, with a lot of fatty, floury, unnatural products + alcohol, then bile will definitely not stand out normally. Therefore, stagnation often occurs in people who are overweight and have diabetes.

5. Violation of the liver cells themselves - of course, affects the structure of bile. Therefore, by the way, if the gallbladder has already been removed due to stones, this does not mean that now everything will be fine with the bile itself. Thick bile can also produce stones in the liver ducts.

The gloomy result of stagnant bile:

• indigestion and absorption of fats
• stool problems
• the formation of a precipitate of their cholesterol in the gallbladder, then it thickens and stones are obtained
• with severe violations of the liver, stones can be bilirubin or cholesterol stones are impregnated with calcium salts, since bile has an alkaline reaction. Then they can't be dissolved.
• the growth of stones makes it even more difficult for the outflow of bile and impairs digestion.
• stagnation of bile itself, of course, does not lead to the formation of atherosclerotic plaques and aging of blood vessels. But if the bile is thick, you can be sure that low-density cholesterol is increased, and high-density cholesterol is not enough for the formation of energy from it in cells. It's as obvious as smoke means there's a fire somewhere.
• lack of energy in cells, decreased performance, tendency to overweight due to improper digestion of fats and excessive intake of heavy cholesterol, bilirubin, and toxins not removed in time.
• decreased immunity, against the background of improper digestion, intoxication and energy deficiency
• risk of liver damage (hepatitis, cirrhosis) due to intrahepatic stagnation of bile, which has nowhere to be released in a timely manner

You see that bile stasis creates global risks of accelerated aging of the body and loss of vitality, the risk of surgery for cholelithiasis and just unpleasant symptoms: heaviness in the right side, discomfort, bitterness in the mouth, stool disorders.

Diet for stagnant bile

There is a very short recipe, and it is the most effective. P looking for biliary dyskinesia should be as simple as possible. During the day, a maximum of vegetables, cereals and a minimum of fatty and starchy foods, we limit smoked products, foods with preservatives and a flavor enhancer - glutamate. Spices can be used for sluggish gallstones, but this does not mean that chili is good for the liver. Everything is in moderation. Coffee and strong tea - only in the morning. Alcohol - without diligence.

Emotions and bile stasis in the gallbladder

Remember the expression "bilious man". Violation of bile secretion negatively affects the central nervous system. Of course, this is not about you, but in extreme cases - with tumors or severe gallstone disease, so much toxic bilirubin is absorbed into the bloodstream that it can even lead to clouding of consciousness.

But also in reverse: when condemnation, irritation, anger boil inside, and even if they do not go outside, they cause spasms in all organs where there is smooth muscle, including. cause cholestasis.

No wonder anger, revenge, jealousy in Orthodoxy are mortal sins. Not only because they do not allow the soul to live fully, but also they kill quite physically - through spasms and disruption of the liver.

If, after looking at your life, you notice that, and would not want to be angry or jealous, but it doesn’t work out, it is worth working with these emotions at least from the instinct of self-preservation - talk to a priest or a psychologist about it.

Start also with cleansing the body. Many people respond in such a way that after the normalization of the work of the intestines, liver, there was more energy, sleep returned to normal, and emotions calmed down.

What is bile and how does it affect health

The liver has about 32 functions, including the production of bile, about 1 liter per day.

If we remember that we have 5-6 liters of blood, then it is clear - the role of this fluid is huge.

What is bile made of? from water, cholesterol (more commonly called cholesterol), bile salts and pigments.

Cholesterol (cholesterol)- a compound involved in the synthesis of steroids, hormones of the sexual sphere, the adrenal cortex and also fat soluble vitamins. For example, Vitamin D is an essential integral part cell membranes: in other words, this is what makes cells hold their structure.

Cholesterol also takes part in the formation of cellular transport channels and the formation of energy in the cell.

Free cholesterol in bile; one part of it is absorbed back in the small intestine, while the other part is hydrolyzed intestinal microflora in the form of coprosterol.

Bile salts are the main constituents of bile and are importance for digestion.

They are sodium salts of glycocholic and taurocholic acids - compounds of cholic acid with glycocol and taurine. In humans, glycocholic acid predominates. 10-20 g of bile acids are formed per day. Bile salts reduce the surface tension of fats and subject them to fine emulsification, which increases the area of ​​action of the lipase enzyme. Their presence helps to digest all fats.

Bile acids, which are an important component of bile, are synthesized from cholesterol. This process takes almost three-quarters of the total cholesterol in the body. These acids are very important for the digestion of food, metabolic processes depend on them.

Bile also contains alkaline phosphatase, an enzyme secreted by the bile duct epithelium., He plays a key role in metabolism- in the first place, in phosphorus-calcium metabolism. Hence the explanation of the influence of the condition of the liver on the risk of osteoporosis. An increase in alkaline phosphatase is also one of the symptoms of damage to liver and pancreas cells.

Another important component bile - pigment bilirubin. It does not take part in digestion, but there is much evil from it if the liver does not work properly with it. And depending on the form, it may simply be a by-product of the functioning of protein metabolism in the liver (direct bilirubin), and it is he who colors the stool brown during transformations in the digestive tract. Physiology textbooks say that this form is non-toxic. But you need to understand - even a low-toxic substance with prolonged exposure for many years to impaired bile secretion can do more harm than a brief poisoning.

But his relative - indirect bilirubin, on the contrary, is very toxic. Its formation: the result of the breakdown of erythrocytes and it must be rapidly excreted in the bile. With bile stasis, indirect bilirubin is absorbed into the blood.

Soluble in water and fatty substances, unconjugated bilirubin easily penetrates into cell membranes and further into their energy centers - into mitochondria, disrupts cellular respiration and oxidative phosphorylation, disrupts protein synthesis, the flow of potassium ions through the cell membrane.

Particularly sensitive to this are the cells of the nervous system, which require a lot of energy to work. Indirect bilirubin, in violation of bile secretion - pronounced neurotoxin.

In its abundance, we see symptoms of yellow discoloration of the skin and pruritus as well as discoloration of feces and darkening of urine.

Dec 26, 2017 Olga