3 Diagnostics

The presence of cholelithiasis can be suspected in the presence of paroxysmal pain in the right hypochondrium, especially accompanied by jaundice.

• Diagnostic Objectives

  • Determination of the presence of calculi in the biliary tract and their relationship with clinical manifestations.

  • Characterization of bile calculi - localization, chemical composition, dimension and quantity.

  • Identification of complications.

 

• Methods for the diagnosis of gallstone disease

In the diagnosis of gallstone disease, along with the characteristic clinical picture, an important role is played by imaging and laboratory diagnostic methods.

• Medical history

When collecting an anamnesis, the limitation of the appearance of such symptoms (paroxysmal pain in the right hypochondrium or epigastrium), their dynamics and frequency of occurrence should be clarified. It is necessary to find out whether the examination was carried out (to obtain data from previous studies for comparison) and the treatment of this disease earlier.

 

• Physical examination

An important role is played by an objective examination of the patient during an attack of pain. In this case, symptoms of muscle protection, increased pain during palpation and percussion of the abdomen in the right hypochondrium, as well as increased pain during palpation of the gallbladder at the inspiratory height - positive symptoms of Murphy and Kera can be determined.

 

• Laboratory diagnostic methods

Laboratory indicators for uncomplicated cholelithiasis, as a rule, are not changed.

After an attack of biliary colic, in 40% of cases there is an increase in the activity of serum aminotransferases ( ALT and AST ), in 23-25% of alkaline phosphatase , γ-glutamyl transpeptidase , in a 45-50% increase in the content of bilirubin . A week after the attack, indicators usually return to normal.

If the course of the disease is complicated by the development of acute cholecystitis, then leukocytosis and an acceleration of ESR are noted .

 

• Visual and instrumental diagnostic methods

The leading role in the diagnosis of gallstone disease is played by imaging research methods.

• Ultrasound of the abdomen

 

• Abdominal x-ray

 

• Computed tomography (CT)

 

• Biliary tract scintigraphy with 99mTc-substituted iminodiacetic acids (HIDA scintigraphy)

 

• Endoscopic Pancreatocholangiography (ERCP)

 

• Magnetic Resonance Pancreatocholangiography (MRPC)

 

• Endoscopic Ultrasonography (EUS)

 

• Cholecystography (oral and intravenous)

Treatment

• Treatment goals

  • A decrease in the intensity of the clinical manifestations of the disease.

  • Preventing or slowing the progression of the disease.

  • Prevention and treatment of complications.

 

• Treatment methods

  • Non-drug activities

It is important to change the lifestyle: stop drinking alcohol, taking hepatotoxic drugs. Activities related to nonspecific therapy are aimed at achieving changes in the diet and lifestyle of patients with cirrhosis. They also include restrictions on the intake of certain medications, compliance with a certain level of physical activity.

It must be remembered that patients with cirrhosis should be actively treated for concomitant infections; prophylactic prescription of antibiotics during any instrumental manipulations (treatment by a dentist, laparoscopy, catheterization) is indicated. At the slightest sign of decompensation, bed rest and inpatient treatment are recommended.

It is forbidden to conduct stress studies, balneological and physiotherapeutic procedures, insolations.

Patients with chronic liver diseases are recommended vaccination against hepatitis A, B, pneumococcal infection and influenza.

• Nutrition for patients with cirrhosis.

Patients in the compensated stage of cirrhosis are prescribed a balanced rational diet. Alcohol should be discarded. Read more: Clinical nutrition for liver diseases ).

A low-protein diet is indicated for patients at high risk of developing hepatic encephalopathy. However, in such patients there is a likelihood of muscle weakness. With the development of signs of encephalopathy, protein nutrition should be reduced to 40.0 g per day with a uniform distribution throughout the day.

With ascites , a salt-free diet is indicated.

• Physical activity.

After consulting a doctor, maintain a certain level of physical activity (for the prevention of osteoporosis). In the compensated stage, patients can perform work that is not related to the forced position of the body, prolonged walking or standing, or fluctuations in ambient temperature. Regular physical activity (walking, swimming) is recommended.

Patients with a more severe course of the disease can also carry out special complexes of physical exercises under the supervision of an instructor.

• Drug restriction.

Patients with chronic liver disease and cirrhosis should avoid taking non-steroidal anti-inflammatory drugs ( indomethacin , ibuprofen ( Nurofen )), isoniazid , valproic acid ( Depakin , Konvuleks ), erythromycin , amoxicillin / clavulanate ( Amoxiclav , Augmentin , ketoconazole ( Nizoral ), chlorpromazine ( Aminazine ), ezetimibe ( Ezetrol ), aminoglycosides.

In patients with decompensated cirrhosis of the liver, non-steroidal anti-inflammatory drugs can lead to gastrointestinal bleeding, renal failure.

It is also recommended to limit the use of medicinal herbs and dietary supplements to food as much as possible.