Etiology

- metabolic dysbalance (impaired cholesteric exchange, adiposity and increased estrogen development);

- hypodinamia;

- an irrational nutrition (high-caloric food, low contents of vegetative fibers in the meal);

- eldery;

- treatment by hyperlipidemic fibrates;

- diseases of the gastrointestinal tract, accompanied with acquire incompetence,

- biliary tract infections and bile;

- hemolytic anemias.

Pathogenesis

- stages of bilious stones formation;

- stage of saturation;

- stage of crystallization;

- stage of growth.

Cholesteric concrements in the gall bladder are formed at presence in it the bile overload by cholesterol. Thus in the liver the superfluous quantity of cholesterol and insufficient quantity of bilious acids is synthesized, including lecithin that is also is in the dissolved condition. As a result cholesterol drops out in a deposit. For the further formation of stones the condition contractivity functions of the gall bladder and presence of inflammatory mucous damage is of important sense. Under influence of nucleation factors (bile glicoproteins) from the dropped out crystals of cholesterol the first microlits appear. In condition of decreased evacuator functions they are start to grow.

Classification

The I stage - the stage of the beginning or prior to the stone formation;

The II stage - the stage of stones formation with indication;

The III stage - the stage of complications.

Clinical features

The most typical complaints are attacks biliary colic. Sudden obstruction of the cystic duct or common bile duct by a gallstone in biliary colic causes epigastric or right upper quadrant steady, aching pain (not colicky) that may radiate to the right scapula and shoulder. This pain is characterized by rapid onset over a few minutes, lasts one to several hours and subsides gradually. Anorexia, nausea, vomiting, restlessness often accompany the pain in biliary colic. Also the patients show complaints to the bitterness in a mouth, sub fibril temperature.

Objective examination. General patient’s condition is from satisfactory to moderate grave. The consciousness is clear and the posture is active or forced. At survey - the raised weight of a body as a rule is defined.

The color of the skin and visible mucosa has corporeal color (cutis colons somatici), without eruption, moderate moisture and elasticity, preserved turgor, may observe transient subicteria of the skin or even yellow color due to obstruction - development of mechanical type of jaundice.

In superficial tentative oriental palpation of the abdomen detect moderate pain in right hypochondria. Muscular resistance, diastases recti, and fluctuation symptoms are negative.

In penetrative palpation of the abdomen identify tenderness in gall bladder point (Ker’s point) and positive Kerras', Murphys', Ortners' and Mussis' symptoms.

Additional methods of examination

Clinical blood analysis - leucocytosis with shift of the formula to the left, accelerated ESR.

Biochemical blood analysis - increase of the common bilirubin due to direct fraction, increase of alanine aminotransferases and aspartate aminotransferases activity (at development of hepatitis and in the period biliary colic), increase activity of alkaline phosphotase and moderate increase of amylase, cholesterol and β-lipoproteins levels.

Ultrasound examination of the digestive organs - revealing the signs of cholecystitis and stones in the gall bladder.

Cholecyctography. About 80 to 85 per cent of gallstones are not radio-opaque and oral cholecystography remains the method of choice for examining the gall bladder with contrast medium to detect calculi when ultrasound is not available or is inconclusive.

Computed tomography - for the diagnosis verification and carrying out of differential diagnostics.