Postcholecystectomy syndrome
Contents:
Description:
The postcholecystectomy syndrome is a syndrome of functional reorganization of work of zhelchevydelitelny system after an operative measure. It includes disturbances of motility of a sphincter of Oddi (a muscular press of outlet opening of the general bilious channel in a duodenum) and disturbance of motive function of the duodenum. Most often there is a disturbance of a tone of a sphincter of Oddi as hypotonia or a hypertension. However, carry to a postokholetsistektomichesky syndrome also states which causes were not removed during operation. These are the stones left in canals, the stenosing papillitis or a stenosis of a bilious channel, a cyst of bilious channels and other mechanical obstacles in bilious channels which could be eliminated during operation, but for various reasons remained unnoticed. Owing to an operative measure there could be damages of bilious ways, narrowings and cicatricial changes of bilious channels. Sometimes incomplete removal of a gall bladder meets, or pathological process develops in a stump of a channel of a gall bladder.
Symptoms of the Postcholecystectomy syndrome:
There is no conventional classification of a postcholecystectomy syndrome. More often in daily practice the following systematization is used:
1. Recurrence of a lithogenesis of the general bilious channel (false and true).
2. Strictures of the general bilious channel.
3. The stenosing duodenal papillitis.
4. Active commissural process (limited chronic peritonitis) in subhepatic space.
5. Biliary pancreatitis (holepankreatit).
6. Secondary (biliary or hepatogenous) gastroduodenal ulcers.
Symptoms:
* weight and dull aches in right hypochondrium,
* intolerance of greasy food,
* eructation bitterness,
* heartbeat,
* perspiration.
Reasons of the Postcholecystectomy syndrome:
Digestive tract diseases which developed owing to long existence of cholelithiasis which proceed further after operational treatment can become the reason of a postcholecystectomy syndrome. It is chronic pancreatitis, hepatitis, a cholangitis, a duodenitis and gastritis. It is considered that stones in bilious channels happen the most frequent reason of a postcholecystectomy syndrome. Stones can be unnoticed and left in canals during operation or again educated. Patients complain of pains in right hypochondrium which have pristupoobrazny character and are followed or not to be followed by jaundice. In the period of an attack urine darkening can be found. At the left stones the first symptoms of a disease appear soon after operational treatment, and again formed stones require time.
Disturbance of a tone and motive function of a duodenum or impassability of a duodenum can become the reason of a postcholecystectomy syndrome.
Treatment of the Postcholecystectomy syndrome:
Treatment of patients from a postcholecystectomy syndrome has to be complex and is directed to elimination of those functional or structural disturbances from a liver, biliary tract (channels and sphincters), digestive tract and a pancreas which are the cornerstone of suffering were a reason for the address to the doctor.
Frequent fractional food (5–7 times a day), observance of a diet with the low content of fat (40–60 g in days of vegetable fats), an exception of fried, acute, acid products is appointed. It is possible to apply Drotaverinum to anesthesia, мебеверин. In cases when all medicamentous options are tried, and the effect of treatment is absent, for recovery of passability of bilious ways operational treatment is carried out. For elimination of relative enzymatic insufficiency, improvement of digestion of fats use the fermental drugs containing bile acids (festal, панзинорм forte) in average daily doses. Existence hidden and furthermore explicit disturbances of digestion of fats means prolonged use of enzymes both with medical, and with preventive the purposes. Therefore duration of a course of treatment is individual. Quite often removal of a gall bladder is followed by disturbance of an intestinal biocenosis. For a vosstanoveniye of intestinal microflora antibacterial medicines (doxycycline, furasolidone, metronidazole, интетрикс), short 5-7-day courses (1–2 courses) are appointed in the beginning. Then treatment is carried out by the drugs recovering an intestinal microbic landscape, promoting growth normally of microflora (for example, bifidumbacterium, линекс). Within 6 months after removal of a gall bladder patients have to be under medical control. It is reasonable to recommend sanatorium treatment not earlier than in 6–12 months after operation.
