Gallstone disease (GSD) is one of the common diseases. In surgical hospitals among patients with chronic abdominal gallstone patients occupy the first place. In the postwar period in the economically developed countries in Europe and North America, the number of patients with gallstone disease has increased significantly. This is evidenced by the number of surgeons performed the operations - for example, only in the U.S. annually more than 500 000 cholecystectomies. In our country also has a high incidence of gallstone disease, and in each subsequent decade, the number of patients doubled. The disease is rightly considered a "disease of the century" and "the disease of prosperity," referring to a direct link its development with the nature of power.
In the past three decades, significant progress in addressing the diagnosis and treatment of brand viagra gallstone disease, largely due to progress in the development of medical technology and basic sciences. Thanks to these advances in medical practice appeared effective diagnostic methods: ultrasonography (U.S.), computed tomography, magnetic nuclear imaging, direct methods of contrasting the biliary tract. Along with this have not lost their value, such methods as oral cholecystography and intravenous holegrafiya. The traditional treatment with open cholecystectomy, laparoscopic techniques were added and malotravmaticheskie of minimal access surgery. Moreover, the disposal of physicians came non-operational methods of treatment: drug dissolution and extracorporeal lithotripsy. Wide range of diagnostic and treatment methods led to a revision of strategy and tactics in GSD. Naturally, it was necessary to optimize the selection of diagnostic tests and therapies for each individual patsmenta.
The need to free the patient from the GSD is dictated not only encountered bouts of biliary colic, but also the risk of severe complications (acute cholecystitis, obstructive jaundice, destructive pancreatitis, etc.) that may require urgent surgical intervention, and with prolonged duration of the underlying disease cancer of the gall bladder. Therefore, treatment must be subject to both patients with symptomatic gallstone disease, and with its latent form, in which there is always the danger of sudden severe complications of the pathological process. Recommendation of a specific patient treatment should be based on an assessment of his physical condition, the nature of the disease, concomitant changes in the bile ducts (stones, stricture). Necessary information can be obtained through a series of instrumental and laboratory tests.
Diagnosis
Ultrasound examination
The main method of diagnosis of cholelithiasis. Its non-invasive, security and ease of implementation make it possible to survey a large contingent of the population and to resort to re-study in the next 23 days in case of failure or Noninformation primary research. Ultrasound can determine: the presence of gallstones, their number and size, the total volume and, more importantly, the qualitative composition of concretions, location, size and shape of the gallbladder, the thickness of its walls and the presence in it of the restrictions, the degree of inflammatory and infiltrative changes; diameter gepatikoholedoha and presence of stones in it. Variant of the functional ultrasonography using a choleretic breakfast allows us to estimate the contractility and evacuation functions of the gallbladder.
Oral cholecystography
The method of X-ray study of the gallbladder, based on oral iodine-containing drugs. Its use is appropriate in cases where it is necessary to have accurate data on the functional status of the gallbladder, radiolucency concretions and their degree of calcification. This information is extremely important for the selection of patients for litoliticheskuyu therapy and extracorporeal lithotripsy (EKLT). One of the drawbacks of this method is the impossibility of contrasting the bile duct, the state where you need to know in all cases without viagra cost per pill exception, when the patient require treatment.
Intravenous holegrafiya
Based on the intravenous injection of contrast solution method makes it possible to get a clear picture not only of the gallbladder, and bile duct. This fact is extremely important for identifying stones in the bile duct, determine the extent of dilation or constriction. Detection cholangiogram even a moderate expansion of the bile duct is an indirect indication of violations of outflow to the intestine, and in this case, more research is needed to identify the causes of biliary hypertension. Intravenous holegrafii absolutely shown in cases where on the basis of anamnestic and clinical signs is suspected in the concomitant loss of bile ducts of the presence of stones and strictures. To remove this suspicion, you can resort to the use of endoscopic retrograde cholangiopancreatography (ERCP). But compared with the diagnostic method of intravenous holegrafiya is gentle and less dangerous method, which is not peculiar to life-threatening complications.
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