Chronic cholecystitis and cholelithiasis in pregnant women


  • Treatment
  • Pregnancy after removal of the gallbladder

  • Diseases of the biliary system is occupiedone of the leading places among digestive diseases. They occur in people of any age, but most often young people, and women are 4-7 times more often than men. Often, chronic diseases of the gallbladder and bile ducts start first in women during pregnancy. For example, one of the factors of risk of stones in the gallbladder is considered a pregnancy.
    Chronic cholecystitis and cholelithiasis in pregnant womenChronic cholecystitis - chronicrelapsing disease associated with the presence of inflammatory changes in the gallbladder wall. In its development of the fundamental role played by two factors: infection and bile stasis due dyskinetic disorders. Recently, as a rule, cause the clinical manifestations of the disease.
    At the heart of dyskinesia of the gallbladder andBiliary are violations of their motor activity, due to disorders of neurohumoral regulation. There are two types of dyskinesias: hyper- and hypokinetic, which have certain differences.

    For pregnant characteristic gipomotornomu violationsas the major hormone dominant in the second half of pregnancy is progesterone relaxes smooth muscle organs (the main physiological significance of its action in the body of the pregnant woman - relaxing the uterus, prevents premature birth, miscarriage). In gipomotornoy dyskinesia is based on insufficient, poor emptying of the gallbladder. That movement disorders and determine the clinical manifestations of chronic cholecystitis in pregnancy, rather than inflammation.

    Typically, a woman concerned about pain in the right upper quadrant. Depending on the type of dyskinesia prevail dull aching pain, feeling of heaviness in the right upper quadrant (with concomitant gipomotornoy dyskinesia), or vice versa, sharp, cramping (with hypermotor). Pain may be accompanied by dyspeptic symptoms: a feeling of bitterness in the mouth, nausea, vomiting, belching air, heartburn, bloating. It has been observed increase in or the appearance of pain after errors in diet.

    Our own long experience of observingpregnant women showed that approximately 1/4 of women suffering from cholecystitis, connect new or worsening pain in the right upper quadrant with fetal movements, and its position in the uterus. Sometimes, a woman worried about skin burning sensation in the right hypochondrium, under the right shoulder blade - the so-called zone of skin hypersensitivity (hypersensitivity) Zakharyin-Ged. To be afraid of unpleasant sensations should not be, because it is a "continuation" of pain, rather than a result of accession of any new disease or complications.

    In the diagnosis of diseases of the gallbladder leadsvalue today belongs ultrasound, during which the expert concludes about the nature of violations detected, the possible presence or absence of stones.

    Pregnancy often worsenspre-existing cholecystitis, an exacerbation of the disease occurs in half the cases, and mostly in the third trimester. In the clinical picture of acute symptoms prevail gipomotornoy dyskinesia. Chronic cholecystitis, in turn, is reflected in the current pregnancy. Often there are painful nausea, morning sickness - vomiting of pregnancy, a little less - drooling. And early toxicosis is tightened to 16 - 20 and sometimes 28 - 29 weeks of pregnancy.


    Principles of treatment of chronic cholecystitis inpregnant women is the same as that of the non-pregnant. Diet therapy (table number 5) is carried out without too much restriction under optimal (for each gestational age), the ratio between proteins, fats and carbohydrates. Restrictions apply refractory fats, roughage, exclude spices, pickles, pickles, fried foods, smoked. The food taken in divided portions at least 5 - 6 times a day. When concomitant gipomotornoy dyskinesia gallbladder diet included "holetsistokineticheskie", that is conducive to the reduction of the gallbladder Products: rather weak meat or fish broth, soup, cream, sour cream, soft-boiled eggs. It is useful to include foods rich in lipotropic substances (cheese, protein omelet, cod).

    It has a positive therapeutic effect in the periodabsence seizures cholecystitis edema and drinking mineral water type Essentuki number 4 and number 17, Smirnov, Slavyanovskaya, sulphate Narzan. Mineral water is used on 200 ml of warm 3 times a day for 1 - 1.5 hours before meals for 14 - 21 days. In the 3 trimester, when it is desirable to reduce the amount of fluid intake, spa treatment is not indicated.

    Everyone, without exception, pregnant, sufferingchronic cholecystitis, recommended cholagogue. In the first place may be mentioned are sorbitol or xylitol which are used in the form of a 10 - 15% solution 50 - 70 ml per 30 minutes before meals 2 - 3 times a day. With laxative effect they can have the benefit of the pregnant and in this respect. The most expedient intake of herbal drugs in the form of decoctions prepared independently. The easiest way - make a tea at the rate of 1 tablespoon of vegetable raw materials (sand immortelle flowers, corn silk, peppermint leaves, fennel seeds, rose hips, barberry root, alone or mixed in a 1: 1) to 1 cup of boiling water. After straining take 1 | 3 cup in the form of heat for 30 minutes before meals 3 times a day. Especially in the second half of pregnancy, when strictly necessary to take into account the amount of fluid intake, convenient to use flamin (Helichrysum extract sand) 1 - 2 tablets 3 times a day for 30 minutes before eating. In the appointment of broth mixture of herbs noted choleretic and a positive urine output, as they have sufficient diuretic.

    To counter the stagnation of bile, pretalking to your doctor, you can conduct "blind" intubation or tyubazh with vegetable oil (30 - 40 ml of corn oil or olive oil), Carlsbad salt or salt Barbara (1 teaspoon per cup of water), mineral water (500 ml in the form of heat, when absence of edema) to conduct of probing the morning on an empty stomach to drink called the means to lie in a warm bed on the right side by 1.5 - 2 hours. Put a hot water bottle is not necessarily pregnant.

    For acute pain in the right upper quadrant, you can take no-silos, baralgin.

    Gallstones (cholelithiasis, calculouscholecystitis) - a disease characterized by the formation of gallstones in the bile ducts and gall bladder. Many scientists are of the opinion that it was the pregnancy, it contributes to the formation of stones, the development of the disease.

    Outside of acute gallstone disease maydisplay a sense of heaviness in the right upper quadrant, near dyspeptic symptoms (nausea, bitter taste in the mouth, etc.). However, in aggravation, ie in the development of bile, also known as biliary colic, a disease has a distinct clinical symptoms, depending on the location of the stones, their size, activity co-infection. Typically, colic develops late in the evening or at night, usually after errors in diet, due to feelings arising from negative emotions (anger emotions often). Jolting ride the day before, intensive fetal movements can also trigger colic. Pain attack in the right upper quadrant, but may be epigastric or even the left upper quadrant, intense pain radiating ( "pays") in the right shoulder blade, neck, extends from 15 - 40 minutes to 12 hours, if measures are not taken.

    right hypochondrium region is feelingsharp pain. The pain is accompanied by nausea, vomiting, bitter taste in the mouth, heartburn, bloating. When occlusion of common bile duct stones may appear jaundice as in acute viral hepatitis, dark urine, discolored feces.

    Pregnancy contributes to the manifestation of hiddenflowing cholelithiasis. That is, women with cholelithiasis appearance of clinical signs of the disease is not uncommon. Quite often in this group of patients the beginning of pregnancy is associated with early toxicosis - vomiting during pregnancy. The aggravation of the disease usually occurs in the second trimester of pregnancy.

    Treatment of gallstone disease is similar in many respects tothose with cholecystitis (health food, light cholagogue). When the pain is admissible intake of painkillers and antispasmodic drugs (baralgin, Noshpa, papaverine hydrochloride, analgin). If, within hours the pain calms down, a woman should see a doctor (to call the brigade ambulance) for a more intensive therapeutic interventions.

    In recent years, for the treatment of gallstonedisease drugs used to facilitate dissolution of stones (heno- and ursodeoxycholic acid), but pregnant women is strictly forbidden to carry out this type of treatment (proved negative influence of these drugs on the formation of the fetus), and indeed crushing stones (shockwave lithotripsy). cholecystectomy surgery (removal of the gallbladder) - In case of emergency during pregnancy, surgical treatment can be carried out.

    Pregnancy after removal of the gallbladder

    In the last two decades around the worldin parallel with the increasing number of patients with chronic gallstone disease is steadily increasing and the number of cholecystectomies. gall bladder operations are the most common, after appendectomy, intervention on the abdominal organs. Approximately 80 - 90% of patients cholecystectomy not cause significant disturbances in the body. However, during pregnancy may occur disorders of the digestive system, and this woman should be ready (but the fear of what will happen "rupture of the liver" - is not justified).

    In some patients after surgical treatment forcholelithiasis developing so-called postcholecystectomical syndrome. It is manifested by pain in the right upper quadrant, dyspeptic complaints (nausea, bitter taste in the mouth, heartburn, etc.), it seems that the disease has returned again. Therefore, all pregnant women who have had a cholecystectomy surgery in the past, you must be supervised by a physician prenatal and carry out preventive measures aimed at preventing the development of complications. They should comply with the diet (5 - 6 times a day in divided portions) and 5 Wallpaper type diet. Showed reception choleretic drugs (eg, flamen), conducting "blind" tyubazh.

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