Pain in the gallbladder
Pain in the gallbladder most often indicates biliary dyskinesia, acute or chronic cholecystitis, cholelithiasis. Less often, pain syndrome occurs against the background of cholangitis, parasitic invasions, neoplasms. To diagnose etiological factors, instrumental imaging is used — ultrasound, cholecystography, ERCP, scintigraphy. Laboratory techniques include bile analysis, clinical and biochemical blood tests. To relieve the symptom, painkillers and antispasmodics, antibiotics, choleretic drugs are prescribed. According to the indications, surgical treatment is carried out — cholecystectomy.
Causes of gallbladder pain
Pregnancy
Biliary dyskinesia
Chronic cholecystitis
Acute purulent cholecystitis
Cholangitis
Cholelithiasis
Parasitic infestations
Postcholecystectomy syndrome
Tumors of the gallbladder
Diagnostics
Treatment
Help before diagnosis
Conservative therapy
Lithotripsy
Surgical treatment
Prices for treatment
Causes of gallbladder pain
Pregnancy
The appearance of pain and discomfort in the gallbladder is caused by the development of cholestasis in pregnant women. Symptoms occur in the 3rd trimester of pregnancy, disappear in the first days of the postpartum period. Pain is caused by stagnation of bile in the biliary tract (VVP). In addition to pain, there is jaundice of the skin and mucous membranes, severe skin itching. Urine becomes dark in color, and feces becomes gray.
Biliary dyskinesia
Functional disorders, which include JP, are the most common cause of gallbladder pain in children, young and middle-aged people. The nature and duration of the pain syndrome is determined by the type of motor impairment. In the hypermotor variant, the pain is cramping, strong, and resembles biliary colic. They appear 20-30 minutes after the end of the meal. Pain is often caused by psychoemotional overstrain.
In the hypomotor variant of dyskinesia, aching or pulling pain in the right hypochondrial region worries. It begins 40-90 minutes after eating, provoked by fatty dishes, alcohol consumption. Unlike hypermotor JP, the pain syndrome is longer — up to several hours. It is accompanied by nausea, vomiting, a feeling of heaviness in the abdomen, alternating constipation and diarrhea.
Chronic cholecystitis
With this pathology, periodic pains are observed, localized on the right in the hypochondrium. They are provoked by taking a large amount of fatty foods, which leads to increased bile secretion and increased load on the gallbladder. In women, the symptoms worsen before menstruation. With chronic cholecystitis, the pain is dull or aching, not intense, combined with bitterness in the mouth, nausea, instability of the stool.
Acute purulent cholecystitis
This disease is characterized by severe cramping pains in the gallbladder area, which appear suddenly. To relieve the condition, a person lies on his side, pulls his knees up to his stomach. A painful attack is accompanied by fever, sweating, tachycardia. When the inflammation passes into the empyema of the gallbladder, the pain reaches maximum intensity, the body temperature rises to 40 ° C.
Cholangitis
In the acute form of inflammation of the bile ducts, there are sharp, severe pains in the right hypochondrium. For them, irradiation into the right shoulder, neck, and the interscapular region is specific. The symptom appears suddenly in combination with febrile fever and jaundice. There is no clear connection of pain with errors in nutrition or other typical factors. At the same time, nausea and vomiting, diarrhea, weakness occur.
Chronic cholangitis is characterized by aching pains in the projection of the gallbladder. They are felt periodically, accompanied by heaviness in the hypochondrium on the right and a feeling of bursting in the epigastrium. The pain syndrome is not intense, does not require taking analgesics. In most cases, the pain disappears on its own after a few hours. Typically, the addition of common symptoms: prolonged subfebrility, increased fatigue.
Cholelithiasis
Pain syndrome is the main manifestation of the disease. A typical attack of GI is called biliary colic. It develops with the abuse of fatty foods, emotional experiences. Suddenly there is intense pain over the gallbladder and in the epigastrium. It radiates into the scapula, lower back, and atrial region. Often the pain is so strong that a person rushes in bed, can not find a position in which the pain subsides.
The attack lasts for several hours. The pains are characterized by a cramping nature, they are not stopped by conventional analgesics. For cholelithiasis, an increase in body temperature is typical simultaneously with the onset of pain syndrome. Clinical symptoms are complemented by severe nausea and vomiting, stool disorders. There are chills, pallor of the skin.
Parasitic infestations
Pain in the right hypochondrium can be a sign of giardiasis. With this pathology, there is a non-intensive pain syndrome. There is no link between pain and diet disorders or physical overstrain. The symptom is combined with the unstable nature of bowel movements, flatulence, nausea. With parasitic infections, intoxication syndrome is also expressed.
Postcholecystectomy syndrome
Symptoms of the disease occur after surgery to remove the gallbladder. Recurrent pain attacks that develop for no apparent reason are specific for postcholecystectomy syndrome. The pains have a different character — cutting, spastic, dull, aching. The soreness is accompanied by dyspeptic phenomena: belching, bitterness in the oral cavity, nausea, bloating. Diarrhea occurs with abundant fetid feces.
Tumors of the gallbladder
Benign organ polyps are characterized by scant symptoms. Periodically, dull pains are felt at the location of the gallbladder, which are not associated with eating. In a small number of patients, the disease manifests itself with sharp pains and spasms in the area of the right hypochondrium, which are provoked by the use of fatty foods or physical exertion.
With gallbladder cancer, the pain syndrome is expressed at an advanced stage. There is a non-intense dull pain over the organ, which appears for no apparent reason. At first it bothers sporadically, and then it becomes permanent. The clinical picture is characterized by a progressive decrease in body weight, lack of appetite, prolonged subfebrile fever.
Diagnostics
Careful collection of anamnesis and eating habits plays an important role in determining the cause of pain syndrome. During a physical examination, a gastroenterologist checks for vesicular symptoms that indicate an inflammatory process. Diagnostic search involves a comprehensive laboratory and instrumental examination of the biliary system. The following methods are used:
Ultrasound of the gallbladder. According to sonography, the size and contours of the gallbladder, the state of the bile ducts are evaluated. During the study, you can notice concretions, spikes. To study the contractile activity of the organ, a test with a choleretic breakfast is shown.
ERCPG. The technique of reverse contrast of the bile ducts is necessary for detailed visualization of their condition, finding small stones that were not visible during sonography. ERCP is performed using an endoscope, so it is both a diagnostic and therapeutic method.
Duodenal probing. Obtaining several portions of bile is necessary for its microscopic and bacteriological analysis. In the bile, an increased number of leukocytes and mucus are detected. When bakposev usually find a mixed bacterial flora.
Radiological techniques. An overview radiography of the abdominal cavity is performed to identify complications — calcification of the gallbladder wall, free gas under the diaphragm. To clarify the diagnosis, cholecystography, MSCT of the abdominal organs, dynamic scintigraphy of the hepatobiliary system are recommended.
Laboratory tests. In the hemogram for inflammatory diseases of the gallbladder, leukocytosis and increased ESR are detected. A biochemical blood test is performed to search for signs of cholestasis (increased alkaline phosphatase and cholesterol levels), and to assess the content of direct bilirubin.
Treatment
Help before diagnosis
With non-intense pain, indicating a chronic process, it is permissible to limit yourself to non-drug methods. The patient is described in detail the nutrition scheme, which involves the exclusion of animal fats, extractives, alcohol. The diet depends on the preservation of the biliary function of the bladder. To increase the volume of bile, mineral waters are prescribed. In case of an acute pain attack, you should go to the hospital as soon as possible.
Conservative therapy
Medical treatment is carried out with uncomplicated forms of gallbladder diseases, there is no risk of organ destruction. At the initial stage, antispasmodics and analgesics are used to remove the painful symptoms. Then etiopathogenetic therapy is selected, which may include several groups of drugs:
Antibiotics. In case of exacerbation of cholecystitis and cholangitis, broad-spectrum antibacterial drugs are used. To accelerate the elimination of bacterial toxins and endotoxins, treatment is supplemented with infusion therapy.
Choleretic agents. After the acute process is stopped, drugs are prescribed that improve the outflow of bile. They are divided into 2 groups: cholekinetics, which stimulate the contractile activity of the gallbladder, and choleretics, which increase the volume of the aqueous component of bile.
UDHK. The use of ursodeoxycholic acid is one of the methods of non—surgical treatment of gallstone disease. With long-term use (up to two years) the active substance dissolves concretions, contributes to the normalization of the biochemical composition of bile.
After the elimination of acute inflammation, physiotherapy techniques are prescribed. In chronic cholecystitis, it is advisable to use reflexotherapy, SMT therapy, electrophoresis. The use of decoctions of medicinal plants with hepatoprotective and choleretic properties is effective. Spa treatment at balneological resorts is recommended.
Cholecystectomy. Gallbladder concretions
Lithotripsy
In calculous cholecystitis, methods of noninvasive crushing of concretions are widely used. In gastroenterology, extracorporeal shock wave and contact lithotripsy are more often performed. Such treatment is characterized by the absence of tissue traumatization, a short rehabilitation period. Lithotripsy is required only for concretions up to 2 cm in size.
Surgical treatment
With biliary colic, destructive forms of cholecystitis, surgical intervention is indicated in an urgent manner. Laparoscopic cholecystectomy is the method of choice. The operation dramatically reduces mortality and the risk of complications, and has a short recovery period. In elderly and debilitated patients, surgeons prefer to use traditional cholecystectomy.
