Cholelithiasis
Gallstone disease is a disease caused by the formation of stones in the gallbladder, less often in the hepatic and biliary ducts. After 40 years, stones are found in 32% of women and 16% of men. In the presence of stones, bile infection is noted in 30% of cases. At the heart of stone formation is the imbalance between the bile stabilizers (bile acids and lecithin) and the amount of substances dissolved in it (calcium carbonate, bilirubin and cholesterol).
Symptoms, course. The asymptomatic course of cholelithiasis is rare. As a rule, in most cases it is replaced by typical attacks of biliary colic or acute cholecystitis. The presence of stones is observed on average in 90% of patients with gall bladder cancer, and among patients with cholelithiasis, bladder cancer develops on average in 4-5%. Postoperative mortality among patients with cholelithiasis is almost 10 times lower than in acute cholecystitis. Gallstone disease is an indication for surgery, since surgery before complications is less dangerous.
Complications of cholelithiasis are caused either by the attachment of infection (acute cholecystitis), or by the migration of stones (development of choledocholithiasis, mechanical jaundice), or by a combination of these two moments (acute cholecystitis with obstruction of the cystic duct, cholangitis). Choledocholithiasis can be complicated by papillitis with the development of cicatrical stricture of the falcon nipple.
Diagnosis is based on clinical examination and additional methods of examination of patients. A survey radiographic examination of the abdominal cavity reveals only radiopaque stones, the content of calcium salts in which exceeds 3%. Ultrasound scanning of the gallbladder and biliary tract is very informative (up to 90%) non-invasive method. It can also be used in acute cholecystitis, mechanical jaundice, when oral and intravenous cholegraphy is ineffective. Distinguish direct (the presence of stones in the bladder and ducts) and indirect (the contrast of the bile ducts with the bladder turned off) radiographic signs of cholelithiasis.
Treatment operative-cholecystectomy with intraoperative examination of bile ducts. The latter includes examination, palpation, transillumination of the bile ducts, and intraoperative cholangiography. When a stone is found in the common bile duct, it is opened, the stones removed and the absence of an obstacle to the outflow of bile is monitored by probing the ducts and choledochoscopy.
After choledochotomy, a dull duct seam is rarely used, most often the duct is drained through the stump of the vesicular duct (according to Pikovsky) or T-shaped drainage (according to Keru). When detecting the stricture of the choledochus and its expansion, anastomosis is imposed above the narrowing (for example, holedohoduodenoanastomoz).
- Surgical diseases
- Abscess
- Abscess appendicular
- Abscesses of the abdominal cavity
- Abscess of the Douglas space
- Intestinal abscess
- Abscess of the lung
- Soft tissue abscess
- Abscesses of soft tissues after injection
- Abscess of liver
- Amoebic liver abscess
- Prostate adenoma
- Actinomycosis
- Aneurysm
- False aneurysm
- True aneurysms
- Aneurysm of the aortic arch
- Aneurysm of descending thoracic aorta
- Dissecting Aneurysm
- Aneurysm of the abdominal aorta
- Aneurysm of peripheral vessels
- Arteriovenous aneurysm
- Aneurimas of the heart
- Appendicitis acute
- Perforation of the appendage
- Appendicular infiltration
- Pielephlebitis
- Atheroma
- Bronchoectasis
- Varicose veins
- Varicose veins of the spermatic cord
- Dropsy of testis and spermatic cord
- Rectal prolapse
- Gangrene gas
- Gangrene lung
- Hemorrhoids
- Hydradenite
- Gynecomastia
- Hernia
- Internal hernias
- Hernias of the esophagus
- External hernias
- Herniated hernias
- Herniated hernia
- Hernia of the white line
- Hernia postoperative ventral
- Herniated hernia
- Rare hernias
- Pincushion
- Phlegmon hernial sac
- False infringement of a hernia
- Hernias with inflammation
- Dumping syndrome
- Diverticulum
- Esophagus diverticulum
- Cervical diverticulum
- Bifurcation diverticulum
- Epiphrenial diverticulum
- Epiphrenial diverticulum
- Diverticulum of the stomach
- Diverticulum of the duodenum
- Meckel's diverticulum
- Jaundice mechanical
- Bile duct stones
- Ventilated stone of choledoch
- Papillotenosis
- Stricture of bile ducts
- Cancer of the head of the pancreas
- Urinary retention acute
- Zollinger-Ellison syndrome
- Foreign bodies of bronchi
- Foreign bodies of the stomach
- Foreign bodies of the esophagus
- Foreign bodies of soft tissues
- Carbuncle
- Brushes and fistulas of the neck are lateral
- Cysts and fistulas of the neck median
- Colitis ulcerative ulcerative
- Coccygeal epithelial passage
- Cryptorchidism
- Bleeding
- Bleeding internal
- Bleeding gastrointestinal
- Varicose veins
- The Mallory-Weiss Syndrome
- Bleeding into the abdominal cavity
- Bleeding pulmonary
- Bleeding external
- Parenchymal hemorrhage
- Crohn's disease
- Lymphadenitis
- Lymphangitis
- Mastitis
- Putrefactive mastitis
- Acute non-lactational mastitis
- Chronic mastitis
- Megacolon
- Mediastinitis
- Intestinal obstruction
- Paralytic intestinal obstruction
- Mechanical intestinal obstruction
- X-ray diagnostics
- Specific types of intestinal obstruction
- Ingrown throat
- Frostbite
- Local cooling
- Burn
- Occlusion of the main arteries
- Acute occlusion of the vessels of the extremities
- Acute occlusion of mesenteric vessels
- Chronic occlusions of arterial vessels
- Obtiterating atherosclerosis
- Aortic ileal type
- Hips and popliteal type
- Peripheral type
- Occlusion of aortic arch branches
- Occlusion of carotid arteries
- Occlusion of the subclavian artery
- Takayasu's syndrome (absence of pulse)
- Chronic occlusion of mesenteric vessels (abdominal toad)
- Stenosis of the renal arteries
- Obliterating thrombangitis
- Raynaud's disease
- Orcoepididymitis
- Acute abdomen
- Acute pancreatitis
- Chronic pancreatitis
- Acute cholecystitis
- Panaritium
- Panaritium cutaneous
- Paronichy
- Panaritium subungual
- Panaritium tendinous
- Panaritium articular
- Panaritium bone
- Penetrating ulcer of the stomach and duodenum
- Peritonitis
- Peritonitis chronic
- Piopevneumotorax
- Pneumothorax spontaneous
- Postcholecystectomy syndrome
- Perforated ulcer
- Covered perforation
- Bedsore
- Prostatitis
- Wounds
- Fistulas of the rectum
- Stenosis of the outlet stomach
- Fracture of anus
- Urethritis
- Phimosis, paraphimosis
- Phlebothrombosis
- Occlusion of subclavian vein
- Phlegmon
- Furuncle
- Cholangitis
- Electric trauma
- Empyema of the pleura
- Congenital intestinal obstruction
- Atresia of the anus
- Congenital cholangiopathy of newborns
- Pylorostenosis
- Embryonic hernia (hernia of umbilical cord)
- Exstrophy of the bladder
- Dropsy of shells of testis and spermatic cord
- Surgical diseases of the chest
- Congenital diaphragmatic hernia
- Congenital cysts of the lungs
- Pneumothorax
- Tracheophishoprine fistula
- Mastitis of newborns
- Acute hematogenous osteomyelitis
- Peritonitis in newborns
- Acute paraproctitis
- Necrotic phlegmon of newborns
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