Often chronic diseases of the gallbladder and bile ducts first begin in women during pregnancy. For example, a pregnancy is considered one of the risk risk factors in the bustling bubble. Read what to do in such cases.
Content
Chronic cholecystitis – Chronic recurrent disease associated with the presence of inflammatory changes in the wall of the gallbladder. In its development, two factors play a fundamental role: infection and bile stagnation due to diskinetic disorders. The latter, as a rule, determine the clinical manifestations of the disease.
Pregnant women are characterized by hypomatural disorders, since progesterone is prevailing in the second half of pregnancy, relaxing all smooth muscle bodies (the main physiological meaning of his action in the body of a pregnant woman – Relaxation of the uterus, obstacle to premature birth, miscarriage). The basis of the hypomotor diskinesia is insufficient, weak emptying of the gallbladder. It is motor disorders that determine the clinical manifestations of chronic cholecystitis in pregnant women, and not inflammation.
Usually a woman is worried about pain in the right hypochondrium. Depending on the type of dyskinesia, stupid nunning pains prevail, a feeling of gravity in the right hypochondrium (with a concomitant hypochotor diskinesia), or vice versa, sharp, grabs (with hypersmotor). Pains may be accompanied by dyspeptic phenomena: a feeling of bitterness in the mouth, nausea, vomiting, belching by air, heartburn, bloating. Recovery or appearance of pain after errors in the diet.
Our own many years of observation experience for pregnant women showed that approximately 1/4 women suffering from cholecystitis connect the emergence or strengthening of pain in the right hypochondrium with fetal movements and its position in the uterus. Sometimes a woman is worried about the feeling of burning skin in the field of right hypochondrium, under the right blade – These are the so-called skin hyperestsey zones (high sensitivity) Zaharin-Ging. It should not be afraid of this unpleasant feeling, as it is «continuation» pain, and not the result of attaching any new disease or complication.
In the diagnosis of gallbladder diseases, the leading value today belongs to an ultrasound study, in the process of which a specialist makes conclusion about the nature of the detected violations, the possible presence or absence of stones.
Pregnancy more often worsens the course of the previously important cholecystitis, the aggravation of the disease happens in half cases, most of its in the third trimester. And in the clinical picture of the exacerbation prevail the symptoms of hypochlorine dyskinesia. Chronic cholecystitis in turn reflects on pregnancy. Often observed nausea, toxicosis – Vomiting of pregnant women, a little less – salivation. Moreover, early toxicosis is delayed to 16 – 20, and sometimes 28 – 29 weeks of pregnancy.
Treatment
The principles of treatment of chronic cholecystitis in pregnant women are the same as non-empty. Diet and therapy (table number 5) is carried out without too limitations when compliance with the optimal (for each period of pregnancy) relations between proteins, fats and carbohydrates. Restrictions relate to refractory fats, coarse food, exclude spices, pickles, marinades, fried dishes, smoked. Food is accepted by fractional portions of at least 5 – 6 times a day. With the concomitant hypoomotor dyskinesia of the gallbladder in the diet turn on «cholecystokinetic», That is, facilitating the reduction of the gallbladder Products: faint meat or fish broths, soups, cream, sour cream, eggs skey. It is useful to include products rich in lipotropic substances (cottage cheese, protein omelet, cod).
It has a positive healing effect during the absence of seizures of cholecystitis and edema drinking mineral water such as Essentuki No. 4 and No. 17, Smirnovskaya, Slavyanovskaya, sulphate Narzan. Mineral water is used by 200 ml in warm form 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 liquid drinking, treatment with mineral waters is not shown.
Everyone without exception to pregnant, suffering chronic cholecystitis, gilded remedies are recommended. First of all, sorbitol or xylitis should be called, which are used in the form of 10 – 15% solution of 50 – 70 ml 30 minutes before meals 2 – 3 times a day. Possessing a relaxing action they can benefit pregnant and in this regard. The most appropriate to receive preparations of plant origin in the form of decoctions prepared by their own. The easiest way – brew both tea at the rate of 1 tablespoon of vegetable raw materials (sandmaker's sand mill, corn stigs, peppermint leaf, dill seeds, rosehip fruits, barberry root, separately or in a mixture of 1: 1) for 1 glass of boiling water. After the filping, they take 1 | 3 glasses in warm form 30 minutes before meals 3 times a day. Especially in the second half of pregnancy, when it is necessary to strictly take into account the amount of fluid consumed, it is convenient to use flamine (sandmander extract sand) for 1 – 2 tablets 3 times a day 30 minutes before meals. When prescribing a decoction of a mixture of choleretic herbs, a positive diurez is also marked, as they have sufficient diuretic effects.
To combat bile stagnation, after consulting with the doctor, you can spend «blind» Sounding or Tubez with vegetable oil (30 – 40 ml of corn or olive oil), a Karlovar salt or salt of Barbara (1 teaspoon on a glass of water), mineral water (500 ml in a warm form, in the absence of edema) for a tubing in the morning on an empty stomach you need to drink these funds, go to the warm bed on Right side by 1.5 – 2 hours. Introduction to put pregnant not necessarily.
With sharp pains in the right hypochondrium, you can take a but-shlu, Baratgin.
Gallgamed disease (choletiasis, calculous cholecystitis) – The disease characterized by the formation of bile stones in bile ducts or anguil bubble. Many scientists adhere to the opinions that it is pregnancy that contributes to the formation of stones, the development of the disease.
Out of exacerbation, bile disease can manifest themselves with a sense of gravity in the right hypochondrium, a number of dispersal phenomena (nausea, bitterness in the mouth and t.D.). However, in exacerbation, that is, with the development of bile, other name of the hepatic colic, the disease has bright clinical symptoms, depending on the location of the stones, their size, the activity of the concomitant infection. Usually colic develops late in the evening or at night, as a rule, after errors in the diet, due to the experiences due to negative emotions (more often emotions of anger). Shaking ride on the eve, intense fetal movements can also provoke colic. Pain attack in the right hypochondrium, but maybe in epigastrics and even the left hypochondrium, intense, pain irradiates («Got») on the right shoulder, shovel, neck, continues from 15 – 40 minutes to 12 hours, if not taken action.
Feeling the area of the right hypochondrium causes sharp pain. The pain is accompanied by nausea, vomiting, bitterness in the mouth, heartburn, bloating. When blocking a common bile duct, the stone may appear jaundice as with acute viral hepatitis, dark urine, discolored feces.
Pregnancy contributes to the manifestation of hidden gallstone disease. That is, women with Holithiasis have the appearance of clinical signs of the disease is not rare. Quite often in this group of patients the beginning of pregnancy is accompanied by early toxicosis – Stretch of pregnant women. The aggravation of the disease is more often in the second trimester of pregnancy.
Treatment of biliary disease in many ways is similar to that of cholecystitis (therapeutic nutrition, light choleretic means). When pain appear, we assume the reception of painkillers and antispasmodic drugs (barallgine, noszpa, papaverine hydrochloride, analgin). If the pain does not calm down for an hour, the woman should appeal to the doctor (call the team of ambulance) for more intensive medical events.
In recent years, drugs contributing to the dissolution of stones (hyheno- and ursodeoxycholic acids) are used to treat gallstone disease, but it is strictly forbidden to carry out this type of therapy (the negative effect of these drugs on the formation of the fetus), as well as the crushing of the concretions (shocking lithotripsy). In case of extreme need during pregnancy, operational treatment can be carried out - the operation of cholecystectomy (the removal of the gallbladder).
Pregnancy after removal of gallbladder
In the past two decades, the number of cholecystectomium is also steadily increasing all over the world in parallel with increasing number of patients with chronic gallpinder disease. Operations on the bustling bubble become most frequent, after appendectomy, interference with the abdominal organs. Approximately 80 – 90% of patients with cholecystectomy causes notable violations in the body. However, during pregnancy, disorders of the digestive system may occur and the woman should be ready for this (but, fear what happens «Burning gap» – not justified).
In part of patients, after surgical treatment, the so-called postcholycytomic syndrome develops on the bile disease. It is manifested by pain in the right hypochondrium, dyspeptic complaints (nausea, bitterness in the mouth, heartburn and t.D.), it seems that the disease returned again. Therefore, all pregnant women who have previously held the operation of cholecystectomy, it is necessary to be under the supervision of a female consultation therapist and conduct preventive measures aimed at preventing the development of possible complications. They should comply with the power mode (5 – 6 times a day, fractional portions) and type 5 diet. The reception of choleretic drugs is shown (for example, Flamina), «blind» Tubaje.
