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Postcholecystectomy syndrome

  1. Reasons
  2. Symptoms
  3. Diagnosis
  4. Treatment

Functional changes in the biliary system after gallbladder removal or after performing another operation on the biliary tract is called

postcholecystectomy syndrome

.

At the beginning of the development of the disease disturbed motility of the sphincter of Oddi (this is the circle of muscle that controls the flow of bile) and motor function of the duodenum.

Form

Currently, the causes of post-cholecystectomy syndrome is indicated only as a malfunction of the sphincter which is caused by the violation of its contractile function, that interferes with the normal flow of bile into the duodenum.

There are other forms of the disease are included in the postcholecystectomy syndrome

  • the formation of stones in the bile duct
  • false or repeated recurrence of stone formation in the bile duct
  • duodenal papillitis
  • active the formation of scar tissue
  • inflammation of the pancreas and bile ducts
  • gastroduodenal

    or different depth defects

  • syndrome long limb when part of the bladder, which remained after the operation, increase in size
  • pericholedochal persistent lymphadenitis.

Reasons

The reasons for the development of post-cholecystectomy syndrome

  • incorrect or incomplete examination of the body during surgery and before her
  • disruption of the functioning of the gall bladder reduces the concentration of bile between meals and it is release into the duodenum during food intake, disturbed secretion of bile, there are digestive disorders
  • reduces the bactericidal action of duodenal contents. This leads to disruption of the intestinal upset, hepatic-intestinal circulation
  • defects operation. The bile ducts are damaged, improperly administered drainage, leaving a long stump, stenosis faterova nipple leave the stones in the biliary tract.

Concomitant diseases that may develop before the operation or after it, are considered

  • the dyskinesia of the duodenum
  • .

Symptoms

When PHES symptoms can be varied. Persistent recurrent episodes of pain that last no more than 20 minutes is one of the symptoms of post-cholecystectomy syndrome, and can appear for 3 months or more. Pain that occur when PHAS can be divided into

  • gallbladder pain (occurs when impaired sphincter function)
  • common pain bile passage (located in the upper abdomen and may spread to the back and right shoulder blade)
  • pancreatic pain (this process mainly involves the sphincter of the pancreatic duct, which occurs in the left upper quadrant and may spread to the back bending forward)
  • chronic pancreatic pain (occurs when the disturbances in the sphincter of Oddi, the character of the pain shingles).

Pain can begin

  • night
  • after a meal
  • may be accompanied by nausea or vomiting.

Diarrhea – related occurrence of frequent loose stools with a very fast passage of bile acids. The digestive phenomena, if these phenomena appear, we can say for sure that bacterial growth of pathogenic microflora is the place to be. Is characterized by such symptoms

  • flatulence
  • bloating
  • diarrhea
  • rumbling in the abdomen.

With the development of the disease interferes with the normal operation of the duodenum that can lead to malabsorption of nutrients in the human intestine

  • diarrhea – chair quickens up to 10 or 15 times a day, it becomes mushy or watery
  • steatorrhea develops when intestinal function of fat absorption, as a result the stool becomes oily
  • there are cracks in the corners of the mouth
  • reduced body weight
  • there is a General weakness of the body
  • increased drowsiness and fatigue
  • hypovitaminosis
  • appears sphincter of Oddi dysfunction.

Diagnosis

There are several methods of diagnosis of post-cholecystectomy syndrome

  • analysis of patient complaints (when the first symptoms immediately after surgery or after some time which the operation was performed, to what extent, is there pain etc.)
  • the history of life (when first there is the formation of stones in the gallbladder how long was the treatment before surgery, as proved disease)
  • family history – the doctor should clarify whether someone from the family disease, associated with malabsorption of nutrients, Crohn’s disease (which is characterized by extensive inflammation of the small intestines or other diseases associated with the gastrointestinal tract)
  • conduct laboratory research

    • make the clinical analysis of blood to determine the possible anaemia or leukocytosis
    • produce biochemical analysis of blood
    • urine analysis – to know the state of the urinary ducts and bladder
    • tests stool for the presence of intestinal worms or protozoans
    • Abdominal ultrasound – using ultrasound to detect the stagnation of bile in the ducts, dilated bile ducts or deformation
    • manometric study of the sphincter of Oddi – this study determined the safety functions
    • Cpgre allows to determine the presence of stones in the biliary tract and simultaneously remove them
    • CT scan – done to assess the condition of the liver, to see the damage or tumors and stones in the bile duct
    • esophagogastroduodenoscopy – with this method inspects the mucosa of the esophagus, duodenum 12, take the mucosa for study.

Treatment

In the treatment of PES assigned diet 5. It is allowed to drink weak tea, bread, juice, cheese (always low fat), vegetable soups, porridge, salads, legumes, lean beef, sour fruit.

Ban use fancy bread, fat meat, mustard, alcohol, ice cream, various foods, watercress, oily fish, spinach, black coffee. Food is assigned a small fractional and to slowly reduce body weight.

The diet included vitamin therapy (folic acid, B12, vitamins C, A, E and iron). Also added to the diet dietary fiber. Used to limit foods that are poorly digested because they are not food enzymes. To treat PHAS need to limit physical and mental stress on the human body.

Treatment of post-cholecystectomy syndrome is carried out also with the help of medication. To control the functions of the sphincter of Oddi, prescribers nitroglycerin, which control the flow of bile from the body.

Prescribe drugs to relieve spasm and pain medicine to reduce pain. Enzymes used to improve digestion. Antacid medications are prescribed to reduce the acidity of gastric juice.

Antibacterial medication necessary to treat bacterial infection if present. If after surgery, scarring, or stones, or whether they appeared in the course of treatment, it is necessary to perform surgical intervention.

Complications

After the surgery may develop complications such as

  • dehiscence due to insolvency operating seams
  • getting an infection in the wound
  • the development of ulcers or abscesses
  • pneumonia
  • SIBR (bacterial overgrowth syndrome)
  • (disease of the arteries of the chronic type, which is starting to develop due to disorders in lipid metabolism, the disease is accompanied by deposition of cholesterol on vascular walls)

  • complications of malabsorption (malabsorption of nutrients and vitamins in the intestine).

The occurrence of the disease is due to deficiency of nutrients, some vitamins and minerals

  • anemia occurs when there is a decrease in hemoglobin (the protein that carries oxygen) and red blood cells in the blood of a sick person
  • reduced body weight
  • develops hypovitaminosis or deficiency of vitamins in the body
  • deformed skeleton
  • develops

    (sexual impotence).

Prevention

Before the operation it is necessary to make a thorough examination of the body, the patient should be proper care and after surgery.

You need to diagnose and treat illnesses, which can play a significant role in the development processes of post-cholecystectomy syndrome. This diseases such as

(in which there is inflammation of the stomach), pancreatitis (when the pancreas becomes inflamed),

(when inflamed gallbladder),

(when in the gallbladder the stones are formed),

(when inflamed small and large intestine) and other diseases.

For the prevention and prevention of the disease need to adhere to a balanced diet (eat foods that contain fiber), to refrain from fried and canned foods, take vitamins and mineral complexes, to refuse excessive alcohol consumption and Smoking.