Gall bladder

Gallbladder cholesterosis

Gallbladder cholesterosis is a pathology characterized by the deposition of cholesterol on the walls of an organ. The pathological condition is often diagnosed in women suffering from atherosclerosis. Many experts consider the disease as the initial stage of gallstone disease.

Description of the disease

What is gall bladder cholesterosis? This is a disease that occurs due to a violation of lipid metabolism. Therefore, the concentration of cholesterol and low density lipoproteins in the bloodstream and bile increases. These compounds violate the rheological properties of the digestive secretion.

As the pathology progresses, epithelial cells of the gallbladder begin to absorb cholesterol. This process leads to deformation and thickening of epithelial cells, a violation of the functionality of the organ. Fat droplets in epithelial cells absorb tissue macrophages. Therefore, they are transformed into foam cells, which disrupts the outflow of lymph.

Altered macrophages extend deep into the muscle wall of the gallbladder, to the epithelial villi. Over time, pathological processes provoke the bonding of villi, therefore, a polypoid growth occurs. The polyp of the gallbladder is able to grow, which provokes a violation of the outflow of bile.

Important! Cholesterol plaques in the gallbladder are characterized by an asymptomatic course, which complicates the diagnosis and treatment of the disease.

Modern classification

Cholesterosis of the walls of the gallbladder can take the following forms:

  • Diffuse form. Pathology leads to damage to all tissues of the gallbladder, in rare cases, cholesterol plaques appear on the walls of the bile ducts,
  • Focal type. The disease causes damage to small sections of the walls of the organ, bile ducts. During diagnosis, you can notice individual cholesterol plaques or yellowish thickenings on the walls of the organ,
  • Polypous form. The disease leads to the appearance of fat protrusions on the inner shell of the organ. With this form of pathology, patients need regular and thorough diagnosis to rule out the development of cancer.

According to the second classification, there is a stoneless form of cholesterosis, which is characterized by the appearance of common symptoms of the disease. With the calculous type, the pathology develops against the background of gallstone disease.

Causes of occurrence

The exact reason for the development of the disease could not be established. Experts believe that the leading role in the pathogenesis of cholesterosis is played by a violation of lipid metabolism. The following provocative factors are distinguished:

  • Dyslipidemia. The condition is characterized by a violation of fat metabolism against the background of abuse of fatty foods,
  • Diabetes. The pathology is characterized by an increase in glucose in the bloodstream,
  • Non-alcoholic fatty liver hepatosis. Pathology leads to excessive accumulation of lipid metabolism products in the liver tissues,
  • Gallbladder dyskinesia,
  • Hypothyroidism The disease is characterized by a decrease in the functional activity of the thyroid gland,
  • The development of abdominal obesity. The condition leads to excessive deposition of fat in the abdomen and abdominal muscles,
  • Gallstone disease, which is characterized by the occurrence of calculi in the digestive organ.

Clinical manifestations

Symptoms of gallbladder cholesterosis resemble the symptoms that are characteristic of most pathologies of the organs of the biliary system. The severity of clinical manifestations depends on the severity of the pathology, the prevalence of the pathological process.

For the disease, the following symptoms are characteristic:

  • Soreness in the right hypochondrium. The pain syndrome is aching in nature, intensifies after errors in the diet (the use of fatty, spicy, smoked foods). Soreness usually occurs in the evening,
  • Nausea after eating fatty foods,
  • Dryness and bitter taste in the oral cavity,
  • Diarrhea gives way to constipation.

Important! In 25% of patients with gallbladder cholesterosis, the symptoms of the disease are completely absent.

When cholesterol polyps appear in the gallbladder, an attack of biliary colic often develops, which is characterized by:

  • Sudden sharp pain in the right hypochondrium,
  • Repeated vomiting, which does not bring relief,
  • General weakness, sweating,
  • Bitterness in the mouth
  • Dizziness
  • Severe nausea
  • Single diarrhea.

With the development of inflammatory processes, the following symptoms develop:

  • Sudden development of pain on the right side of the abdomen,
  • Sharp bitterness in the oral cavity,
  • Multiple diarrhea
  • Severe nausea and vomiting, which does not relieve the condition,
  • Temperature increase up to 39 0 С,
  • Apathy, weakness, increased fatigue.

What are the possible complications?

Violation of the outflow of bile leads to stagnation of the digestive secretion, increases the risk of secondary bacterial infection. If a patient develops acute cholecystitis on the background of cholesterosis, then the following symptoms join: nausea, vomiting, fever.

If cholesterosis is not treated on time, then the patient develops biliary sludge against the background of pathological processes, which is the initial stage of gallstone disease. In this case, calculi can occur in the cavity of the gallbladder, in the ducts.

Important! With the rapid growth of polypous formations, malignancy of the mucous membrane of the gallbladder can occur.

When lipid deposits cause obstruction of the sphincter of Oddi, acute pancreatitis develops, which is characterized by pronounced symptoms. If the functionality of the sphincter is partially impaired for a long time, then signs of a chronic form of pancreatitis appear.

Diagnostic measures

In the absence of calculi and inflammation in the gallbladder, cholesterosis is asymptomatic. In such cases, the disease is diagnosed accidentally as part of a planned routine medical examination, ultrasound of the organs of the biliary system, cholecystectomy. If you suspect the development of cholesterosis, patients are prescribed the following types of examinations:

  • Biochemical blood test. Characteristic increase in cholesterol and low density lipoproteins,
  • Ultrasound of the hepatobiliary system. During the procedure, the doctor notes a thickening of the walls of the organ. With the diffuse type, individual echopositive regions are visualized. If a polypous or focal form is diagnosed, then the specialist notes parietal formations or local thickening of the wall. To improve the accuracy of diagnosis, during the procedure, the patient is given choleretic products,
  • MRI and CT. Studies can determine the thickening of the walls of the gallbladder, the appearance of biliary sludge, polypoid growths,
  • Cholecystography. The method is used to diagnose polypous forms of the disease. However, the procedure allows only in 40% of cases to differentiate a cholesterol polyp with tumors and parietal calculi.

How is the therapy carried out?

Conservative treatment of gallbladder cholesterosis is indicated only in the absence of complications in patients. The main goal of therapy is to prevent the progression of pathology, normalization of the digestive organ. Drug treatment includes such moments:

  • Taking drugs that restore the functionality of the gallbladder and normalize the rheological characteristics of bile. For this purpose, drugs based on ursodeoxycholic acid (Ursofalk, Ursodez) are widely used. Regular intake of drugs helps to dissolve cholesterol formations, reduces the rate of cholesterol absorption by epithelial cells,
  • The appointment of vitamin complexes,
  • Reception of statins (Atorvastatin, Rozuvostatin). This group of drugs reduces the concentration of cholesterol in the bloodstream,
  • Prokinetics (Domperidone, Mebeverin, Trimedat). Drugs are prescribed by the attending physician to normalize the motility of the gallbladder,
  • Antibacterial agents. If against the background of cholesterosis there are signs of a bacterial infection, then antibiotics of a wide spectrum of action are indicated.

Important! If the patient develops severe symptoms of cholesterosis, calculi in the gall bladder, cholestasis, then surgical intervention is indicated.

Features of diet therapy

A diet for gallbladder cholesterosis is an important component of conservative therapy. Experts recommend switching to fractional nutrition, which involves eating food every 3.5 hours. Foods must be taken warm, chewed thoroughly. Overweight patients should reduce the calorie intake to 1600 kcal per day.

Dietary nutrition requires compliance with the following principles:

  • Eating plenty of fiber-rich plant foods
  • Limiting the use of animal fats - vegetable oils should be included in the diet,
  • Drink mineral water regularly, which is low in salt,
  • Refuse should be from canned products, legumes, smoked, spicy and fried foods, radishes, radishes and cabbage, fatty meat and fish, alcohol, strong coffee,
  • The regular use of seafood and sea fish is shown,
  • The menu should include cereals in half milk, vegetables and fruits.

Can I use folk recipes?

Facilitate the patient's condition will help treatment with folk remedies. Recipes based on medicinal plants can effectively clean the gall bladder, normalize the digestive organ, eliminate unpleasant symptoms of the disease.

For this purpose apply:

  • Beetroot juice. To normalize the outflow of bile, it is recommended to take 50 ml of freshly squeezed juice before each meal,
  • Rhizome of dandelion. Raw materials must be collected in April - May during flowering. The rhizome must be thoroughly washed, peeled, and ground. Then 100 g of raw material is poured into 200 ml of boiling water, the composition is brought to a boil. Chilled broth should be taken 30 ml before each meal,
  • Herbal teas based on calendula, parsley, immortelle, birch buds, corn stigmas, mint, chamomile flowers, rose hips. The listed plants can be used individually or in combination.

Prognosis for cholesterosis

The disease does not provoke severe changes in the work of the gallbladder, is often asymptomatic, therefore cholesterosis is characterized by a favorable prognosis. Sometimes with age, pathological changes in the organ go away on their own if the patient adheres to dietary nutrition.

If cholesterosis proceeds against the background of acute or purulent cholecystitis, cholelithiasis, the disease has an unfavorable prognosis. In such cases, patients need a cholecystectomy. After surgery, you will need to strictly adhere to dietary nutrition for several years.

Preventive actions

To prevent the development of cholesterosis, it is recommended to adhere to such tips:

  • Follow dietary guidelines
  • To refuse from bad habits,
  • Take drugs that normalize blood cholesterol,
  • Twice a year, undergo a routine examination by a therapist and gastroenterologist.

Gallbladder cholesterosis is a pathology that causes lipid deposition on the walls of the digestive organ. In most patients, the disease is characterized by an asymptomatic course, which can complicate the diagnosis of the disease. For the treatment of pathology, conservative therapy is widely used, only in rare cases surgical intervention is indicated.

Causes of gallbladder cholesterosis

A reliable reason for the development of gallbladder cholesterosis has not been established, but it is clear that this pathology is a consequence of lipid metabolism disorders. Thus, any disease accompanied by an imbalance in the processes of synthesis and breakdown of lipids in the body inevitably provokes the appearance of signs of gallbladder cholesterosis.

Predisposing factors for the development of cholesterosis include: endocrine pathology of the thyroid gland with concomitant hypothyroidism, fatty hepatosis, accompanied by excessive accumulation of fat metabolism products in the liver tissue, the presence of a large number of cholesterol stones in the lumen of the gallbladder.

Recent randomized trials in the field of gastroenterology and surgery have shown a correlation between the occurrence of cholesterosis and the presence of signs of enhanced bacterial proliferation in the intestinal lumen under the influence of the used antibacterial drugs and severe immune disorders.

Persons with signs of an abdominal type of obesity are prone to the development of cholesterosis, since this disease causes total metabolic disturbances with excessive accumulation of fat metabolism products in all structures and tissues, including the gall bladder.

It should not be thought that with a normal lipid profile, the patient cannot develop gallbladder cholesterosis, since intracellular cholesterol transport plays a more significant role in the pathogenesis of this disease. Under normal conditions, a small amount of absorbed unesterified cholesterol is located on the surface of the inner wall of the gallbladder. A smaller portion of cholesterol saturates the serous layer of the gallbladder, and the rest enters the bile again. Violation of the process of removing excess cholesterol from the gallbladder can be triggered by the relaxing effect of progesterone on the vascular walls, as well as pathological changes in the lymphatic vessels. The state of the evacuation function of the gallbladder, which can weaken when the nerve plexus is located directly in the wall of the bladder, has a great influence on the transport of lipids.

Symptoms of gallbladder cholesterosis

The clinical picture of gallbladder cholesterosis has, as a rule, a slowly progressing course and a long latent period, during which the patient does not notice any changes in his own health at all. This pathology is almost never established only on the basis of the existing clinical symptom complex, since cholesterosis of the gallbladder does not have specific manifestations that distinguish it from other pathologies of the gastrointestinal tract.

Patients with gallbladder cholesterosis complain of frequent episodes of pain, localized in the projection of the right upper quadrant of the abdomen, the appearance of which is provoked by a violation of the diet. The appearance of pain of this localization in the evening time of the day allows a specialist to suspect the patient has an exchange-dystrophic gallbladder disease.

For this category of patients, the onset of symptoms related to the category of dyspeptic disorders is very characteristic (nausea, which has a clear connection with the intake of fatty foods, heartburn in the morning, intestinal disorders in the form of alternating episodes of diarrhea and constipation).All of the above symptoms are permanent and have a moderate severity, so the patient rarely seeks medical help.

In a situation where gallbladder cholesterosis is complicated by inflammatory changes and the formation of cholesterol stones, there is a significant deterioration in the patient's condition and the appearance of signs of typical biliary colic. The debut of an attack of calculous cholecystitis is the appearance of acute dagger pain in the abdomen, which does not have a clear localization and is accompanied by irradiation to nearby anatomical regions, repeated urge to vomit, the implementation of which does not end with a relief of the patient's condition, a sharp relaxation of the stool with frequent episodes of diarrhea and an increase in body temperature hectic type with concomitant signs of intoxication syndrome.

In a situation where cholesterosis of the gallbladder is not accompanied by the formation of calculi, the patient has no pronounced clinical manifestations for a long period of time, and with calculous cholesterosis, signs of impaired gallbladder evacuation function come to the fore. A special morphological form of this pathology is considered to be "polypoid cholesterosis", the detection of which is considered the lot of specialists in the diagnostic profile, but with a significant increase in the size of polyps, violent clinical symptoms characteristic of biliary tract diseases develop.

Gallbladder Cholesterosis Treatment

For a long period of time, gallbladder cholesterosis was considered an absolute indication for the use of cholecystectomy, however, at present, accurate instrumental imaging methods allow a more detailed study of the preservation of gallbladder function and the possibility of delaying surgical treatment.

You should not resort to medical treatment of cholesterosis immediately after diagnosis in an ultrasound scan or computed tomography. Most gastroenterologists are committed to wait-and-see tactics, backed up by recommendations for correcting eating behavior and dynamically monitoring gallbladder changes using radiation imaging techniques. However, the instrumentally confirmed presence of a polypoid form of cholesterosis in a patient is an indication for the use of active drug therapy, regardless of the number and size of existing parietal polyps.

It should be borne in mind that a decrease in the number of polyps during an ultrasound examination in dynamics is not an indication for stopping treatment, since these neoplasms are prone to self-amputation even in the absence of therapeutic measures. In a situation where the entire inner wall of the bladder is covered with polyps, surgical treatment is recommended, since an adenomatous lesion of the gallbladder wall, which is not accessible for visualization, may be hidden behind the echostructure of multiple polyps.

When deciding on the appropriateness of conservative treatment in a particular patient, the assessment of the contractile function of the gallbladder should be a priority, and in a situation where the emptying rate does not reach 30%, one should not expect positive results from drug therapy.

All drugs used in the treatment of cholesterosis of the gallbladder are aimed at alleviating the patient’s condition by the method of symptomatic therapy, stopping the progression of pathological processes in the gallbladder, correcting the lipid profile and preventing possible complications.

Preparations of the symptomatic series are considered drugs that eliminate the signs of functional dyspepsia (Motillium, Metospazmil in a daily dosage of 300 mg orally). The action of these drugs is aimed at improving the motor evacuation function of the upper digestive tract, in connection with which, most patients with cholesterosis in the first day of use of the drug note the elimination of nausea, heartburn, flatulence.

The presence of severe pain in patients with biliary colic is an indication for the use of parenteral antispasmodics (Riabal 2 ml intramuscularly, followed by switching to taking the tablet form of the drug), the action of which is aimed at relaxing smooth muscles.

In order to prevent the development of calculi in the lumen of the gallbladder, it is recommended that all patients suffering from cholesterosis take long-term drugs of the bile acid group (Ursokhol in a daily dose of 15 mg per 1 kg of patient body weight). According to randomized trials, drugs of this pharmacological group contribute to self-amputation and subsequent dissolution of parietal polyps of small sizes.

Due to the fact that the so-called “sludge syndrome” is of great importance in the pathogenesis of the development of cholesterosis of the gallbladder, pathogenetically justified in this situation is the appointment of 1 capsule three times a day to the hepatoprotective Hepabene patient, which not only has a choleretic effect, but also improves contractile biliary tract function.

Recently, an ever smaller percentage of gallbladder cholesterosis undergoes surgical treatment and this is associated with improved diagnostic capabilities, however, there are undeniable absolute indications for cholecystectomy, which include:

- the inability to differentiate cholesterosis and a neoplastic process in the wall of the gallbladder,

- lack of positive results from the use of drug treatment and negative echoscopic dynamics,

- contractility of the gallbladder at a level of less than 30%,

- the presence of multiple calculi,

- Frequent exacerbations of cholecystitis.

Diet for cholesterosis

Despite the rapid development of the pharmaceutical industry, which produces a huge number of drugs that can successfully eliminate the signs of gallbladder cholesterosis, representatives of the world association of gastroenterologists insist on the need for non-drug conservative therapy for this category of patients.

The basis of the conservative treatment of cholesterosis is dietary recommendations, tips for restructuring the culture of eating behavior, allowing to normalize the patient’s weight and improve metabolic transformations in the body.

Gallbladder cholesterosis is considered by many experts as a background disease for the further development of cholecystolithiasis and calculous cholecystitis, therefore, the use of a diet can be considered a preventive measure.

When compiling a daily diet for a patient with diagnosed cholesterosis, the following recommendations should be followed:

- food should be reusable and cover the needs of a person in all vital elements,

- when choosing meat products, preference should be given to coarse fiber low-fat varieties (duck, goose, chicken, veal),

- unlimited consumption of dairy products and vegetables,

- refusal to use even small doses of hard liquor.

In addition to the constant observance of the principles of dietary nutrition, the patient is recommended to increase physical activity, during which the additional breakdown of fats and the removal of their metabolites from the body are enhanced.

Watch the video: Gallbladder Problems: Symptoms, Causes, and Treatment Options - St. Mark's Hospital (December 2019).