Gallstones

　　Pathogenic factors for stones in different parts

　　Urolithiasis: Many factors influence the formation of urinary tract stones. The salts that form crystals in the urine are in a supersaturated state, and the lack of substances that inhibit crystal formation in the urine and the presence of nucleating matrices are the main factors for stone formation.

　　Gallstones: They are formed under the influence of various factors through a series of pathophysiological processes. These factors include changes in bile composition, supersaturation of bile or cholesterol, precipitation of bile vesicles and cholesterol monocrystals, imbalance between promoting and inhibiting nucleation factors, abnormal gallbladder function, the participation of oxygen free radicals, and biliary bacterial and parasitic infections.

　　Kidney stones: The main cause is diet, which is caused by excessive intake of components that can form stones in the diet, including: excessive accumulation of oxalate, defective purine metabolism, excessive fat intake, increased sugar content, and excessive protein intake. The high content of calcium salts in water is also one of the factors.

　　Gallbladder stones may not cause any symptoms throughout a person's life, but most gallbladder stones can lead to a variety of complications, even life-threatening ones if not treated properly:

　　1. The most common complication of gallbladder stones is the occurrence of chronic cholecystitis.

　　2. Gallstones may become impacted in the gallbladder neck or cystic duct, leading to acute cholecystitis, gangrene of the gallbladder, gallbladder perforation, peritonitis, and other complications.

　　3. Gallstones (especially small stones) can lead to acute pancreatitis, even life-threatening acute necrotizing pancreatitis.

　　4. Gallbladder stones can cause Mirizzi syndrome, with symptoms such as jaundice and fever.

　　5. Gallstones can cause gallbladder-gastrointestinal fistula (gallbladder communicates with the gastrointestinal tract), sometimes forming biliary stone intestinal obstruction.

　　6. Gallbladder stones can cause inflammatory polyps of the gallbladder.

　　7. Gallbladder stones are an important factor in the development of gallbladder cancer.

　　8. Gallstones can cause atrophic cholecystitis, that is, inflammation causes the gallbladder to shrink in size, the gallbladder wall to thicken, and adhesions around the gallbladder.

　　9. Gallbladder stones can cause chronic suppurative cholangitis.

　　10. Gallstones can secondary to common bile duct stones, severe cases can cause obstructive jaundice and acute suppurative cholangitis.

　　11. Gallbladder stones can cause ceramic gallbladder.

　　12. Gallbladder stones can cause biliary-cardiac syndrome, etc.

　　Liver and gallbladder stones

　　1. Gallbladder stones: Generally, they do not cause colic, and larger stones are not easy to cause obstruction, which can be asymptomatic for a long time. Sometimes, there may be a feeling of fullness or dull pain in the upper abdomen after eating, which is often related to eating greasy food. In daily life, there are often symptoms of indigestion such as heartburn, belching, and bloating, which are often misdiagnosed as 'gastric disease' or 'hepatitis'. Smaller stones can often move and become impacted at the neck of the gallbladder, causing severe cholecystocolic colic, accompanied by nausea and vomiting; if the position of the impacted stone changes and the obstruction is relieved, the cholecystocolic colic can be relieved. There is no infection in the early stage of the disease, so there is no chills and fever. When accompanied by infection and obstruction, the gallbladder may become suppurative, gangrenous, and even perforated. Acute attacks usually occur after a meal or after eating greasy food. When lying flat, gallbladder stones are easy to slip into the cystic duct and cause obstruction, so some patients may have attacks at night. If the patient changes their position at this time (such as sitting up or sleeping on the side), the stones become loose, fall, return to the gallbladder, the obstruction is relieved, and the pain will decrease or disappear.

　　2. Common bile duct stones: Stones can come from the gallbladder or intrahepatic bile duct, or originate from the common bile duct. Smaller gallbladder stones can fall into the common bile duct through the cystic duct, forming secondary common bile duct stones, causing obstructive jaundice and cholangitis. About 75% of patients experience jaundice, and the depth of jaundice varies with the degree of stone impaction and has fluctuating ups and downs. If biliary stones block the bile duct and are accompanied by infection, symptoms such as abdominal pain, high fever, and jaundice may occur simultaneously.

　　3. Intrahepatic bile duct stones: In recent years, the number of patients with intrahepatic bile duct stones has been decreasing. According to my clinical statistics, these stones are usually yellow-brown, lumpy, or sandy bile pigment stones, and their chemical composition is mainly bilirubin calcium. Bacterial infection, biliary ascariasis, and bile duct obstruction are closely related to the occurrence of intrahepatic bile duct stones, and may also be caused by bile duct stricture or poor bile flow after surgery. Clinical manifestations can vary depending on the location of the lesion. When stones descend into the extrahepatic bile duct and cause bile duct obstruction or acute inflammation, symptoms such as upper abdominal colic, chills, high fever, and jaundice may occur. If the stones do not fall off into the extrahepatic bile duct, infection may also occur, and symptoms such as chills and high fever may occur, and in severe cases, toxic shock may occur. However, abdominal colic and jaundice may not appear in patients, so it is often misdiagnosed. Sometimes, intrahepatic bile duct stones may cause liver lesions due to long-term obstruction of the intrahepatic bile duct, such as liver tissue necrosis, forming abscesses, and finally causing part of the liver to atrophy and lose normal function.

　　Urological system stones

　　There are usually several locations with specific manifestations, such as ureteral stones, kidney stones, renal pelvis stones, renal pelvis stones, and bladder stones.

　　Ureteral stones: Primary ureteral stones are often gradually enlarged or located in diverticula, and may have no pain symptoms in the early stage. Secondary stones are often suddenly embedded in the urethra, often causing sudden urethral pain and dysuria. Pain may radiate to the glans penis, perineum, or rectum. Stones can cause incomplete obstruction of the urethra, with symptoms such as thinning of the urine stream, bifurcation, and weak emission, accompanied by frequent urination, urgency, and dribbling. Secondary urethral stones, due to the sudden embedding of stones in the urethra, often cause sudden interruption of urination, with a strong urge to urinate and urgency in the bladder, and often occur with acute urinary retention. Emergency patients often have terminal hematuria or initial hematuria, or a few drops of fresh blood at the end of urination. It is often accompanied by severe pain; chronic patients often have mucous or purulent secretions in the urethra. Most patients can feel hard nodules with tenderness locally in the urethral stones. Posterior urethral stones can be palpated through rectal examination. Multiple stones in the urethral diverticula can be felt as a sand-like friction sensation.

　　Kidney stones: Detected during physical examination with B-ultrasound, urine examination is negative or with a small amount of red and white blood cells. Larger kidney stones in the renal pelvis, such as cast stones, may cause hematuria after strenuous exercise. Smaller stones may cause microscopic or gross hematuria, and there may be significant tenderness in the renal area. During the attack of pain, the patient may have pale complexion, cold sweat, rapid and weak pulse, even blood pressure drop. Nausea, vomiting, and abdominal distension are often accompanied by gastrointestinal symptoms. Sand grains or small stones may be excreted with urine during the attack of pain and hematuria. When stones pass through the urethra, there may be a feeling of urethral obstruction and piercing pain. After the stones are excreted, the urine flow immediately returns to normal, and the patient feels relaxed and comfortable. Infection may cause purulent urine, and acute attacks may have symptoms such as chills, fever, back pain, frequent urination, urgency, and dysuria.

　　Bladder stones: May have no special symptoms. Pain may be caused by the stimulation of the bladder mucosa by the stones. It is manifested as dull pain in the lower abdomen and perineum, which may also be obvious or severe pain. The symptoms of pain worsen after activity, and the pain may be relieved after changing body position. It is often accompanied by symptoms such as frequent urination, urgency, and dysuria, with increased pain at the end of urination. When stones are embedded in the bladder neck, there may be significant difficulty in urination, with typical symptoms of interrupted urination, and may also cause acute urinary retention.

　　(1) Develop the habit of drinking plenty of water

　　Drinking plenty of water can dilute urine, reduce the concentration of crystals in urine, flush the urinary tract, and is beneficial for preventing the formation of stones and promoting the excretion of stones. Generally, adults should drink more than 2000 milliliters of plain water or magnetized water per day, which is meaningful for preventing stones.

　　(Two) Resolve urinary tract obstruction factors

　　Actively deal with urinary stricture, benign prostatic hyperplasia, and other conditions to relieve urinary tract obstruction.

　　(Three) Active treatment of urinary tract infection

　　(Four) For patients who have been confined to bed for a long time, it is recommended to encourage and help them to be more active to reduce bone demineralization and improve urine flow.

　　(Five) Adjusting urine pH

　　Adjusting the urine pH according to the composition of urinary stones can prevent the recurrence of stones, such as uric acid and oxalate stones forming in acidic urine, and phosphate and carbonate stones forming in alkaline urine.

　　(Six) Prevention and treatment of metabolic diseases, such as hyperthyroidism should be treated with surgery. Develop the good habit of drinking more water

　　(Seven) Dietary adjustment and drug prevention

　　1. Urinalysis: Refers to the presence of a large number of oxalate or phosphate crystals that can be found in the urine regardless of the presence of red blood cells; if there is a concurrent infection with stones, pus cells can also be found in the urine;

　　2. Abdominal X-ray: This is the most valuable examination for the diagnosis and treatment of urinary tract stones. About 95% of kidney stone patients can be visualized on X-rays. If necessary, further intravenous pyelography should be performed to understand the renal function and the condition of renal hydronephrosis;

　　3. Ultrasound: It is economical and simple, and can also make a diagnosis for positive stones and occult stones that cannot be detected by X-rays. However, its disadvantage is that the visualization of lower and middle ureteral stones is not satisfactory;

　　4. CT scan: It can be used for patients with kidney stones that cannot be visualized on X-rays, but it is expensive and not included in routine examinations;

　　5. Cystoscopy and retrograde urography: This method is mainly used for patients whose IVP is not ideal or for those allergic to contrast agents.

　　Increase water intake

　　Do not hold urine. Drinking more and urinating more can help bacteria, carcinogens, and substances prone to forming stones be quickly excreted from the body, reducing the chance of kidney and bladder damage.

　　Reduce beer consumption

　　Some people believe that beer can diuretic and prevent the occurrence of kidney stones. In fact, the malt extract in beer contains acidic substances such as calcium, oxalate, uridine nucleotides, and purine nucleotides, which can interact with each other to increase uric acid in the body, making it an important诱因 for kidney stones.

　　Meat

　　It is recommended to eat less animal organs and control the intake of meat and animal organs because the metabolism of meat produces uric acid, and animal organs are high in purines, which can also produce high blood uric acid during metabolism. Uric acid is a component that contributes to the formation of stones. Therefore, daily diet should be mainly vegetarian, and more foods rich in fiber should be consumed.

　　Reduce salt intake

　　Excessive salt in diet will increase the workload of the kidneys, and salt and calcium have a synergistic effect in the body, which can interfere with the metabolism of drugs for the prevention and treatment of kidney stones. The daily intake of salt should be less than 5 grams.

　　Be cautious when eating spinach

　　According to statistics, more than 90% of kidney stones contain calcium, and about 87.5% of them are calcium oxalate stones. If the intake of oxalates in food is too high, and the calcium oxalate in urine is in a supersaturated state, the excess calcium oxalate crystals may precipitate from the urine and form stones. Among foods, spinach has the highest content of oxalates, and it is also one of the vegetables commonly eaten by people.

　　Don't drink milk before going to bed

　　Because milk contains a lot of calcium, and most stones contain calcium salts. The most dangerous factor for stone formation is the sudden increase in the concentration of calcium in urine for a short period of time. Two to three hours after drinking milk is the peak time for calcium to be excreted by the kidneys. If one is in a state of sleep at this time, the urine becomes concentrated, and more calcium is excreted by the kidneys, so it is easy to form stones.

　　Not suitable to eat too much sugar

　　After taking sugar, the concentration of calcium ions in urine, oxalic acid, and the acidity of urine all increase. The increase in uric acid can make uric acid calcium and oxalate calcium more prone to precipitation, promoting the formation of stones.

　　Eat dinner early

　　The peak period for calcium excretion in humans often occurs 4 to 5 hours after meals. If the dinner is late, when the peak period of calcium excretion arrives, people have gone to bed and fallen asleep, and the urine accumulates in the ureters, bladder, and urethra, and cannot be excreted out of the body in time, causing the calcium in the urine to increase continuously, which is easy to precipitate into small crystals, and over time, gradually expand into stones.

　　Eat more vegetables and fruits

　　Vegetables and fruits contain vitamin B1 and vitamin C, and their final metabolic products in the body are alkaline. Uric acid is more soluble in alkaline urine, so it is beneficial for the treatment and prevention of stones.

　　Reduce protein intake

　　Studies have shown that a high-protein diet can increase the incidence of urinary stones. Therefore, restricting protein in food, especially animal protein, is beneficial for all patients with stones.

　　Can be treated with surgery or laser lithotripsy. Holmium laser lithotripsy is much safer and more versatile compared to currently commonly used extracorporeal shock wave lithotripsy and pneumatic ballistic lithotripsy. Extracorporeal shock wave lithotripsy (ESWL) uses a liquid electro or electromagnetic shock wave generator to emit high-energy shock waves that penetrate the human body, focus on the urinary tract stones inside, release energy to break up the stones, and the stone fragments are naturally excreted. Shock wave lithotripsy is produced by the use of liquid electro, piezoelectric, or magnetostrictive shock waves. It is generally used for gallstones less than 20mm in size, not more than 2 to 3 in number, and with good gallbladder function. After the gallstones are broken up, they can be excreted naturally. At the same time, oral ursodeoxycholic acid can be taken to enhance the effect. Generally, bile acids are started a few weeks before the lithotripsy and continued for 3 months after the stone fragments are completely gone.