Žlčníkové kamene

14.4.2012 , Zuzana Boučková

zlucnikove-kameny3.jpg - kopie
zlucnikove-kameny3.jpg - kopie
Žlčníkové kamene sa môžu vyskytnúť ako v žlčníku, tak v žlčových cestách. Medzi najväčšie riziká žlčníkových kameňov patrí vznik tzv. biliárnej koliky, kedy sa v žlčových cestách zakliní kameň. Vzniká potom zápal, ktorý môže mať ťažký priebeh a nakoniec musí byť žlčník chirurgicky odstránený. Žlčníkové kamene sa dajú rozdeliť do niekoľkých skupín podľa zloženia.

Žlčníkové kamene

Žlčník je malý vačok pod pečeňou, ktorý slúži na skladovanie zásob žlče. Tá do neho priteká žlčovodmi z pečene a v prípade potreby odteká spoločným žlčovodom do dvanástnika, kde napomáha tráveniu. Pôvodná pečeňová žlč obsahuje pomerne vysoké percento vody, v žlčníku sa však zahusťuje. Voda tu prechádza do buniek sliznice a následne je odvádzaná preč. Za normálnych okolností obsahuje žlčník dospelého jedinca asi 50 ml žlče. V žlčníku môžu z rôznych dôvodov vznikať žlčníkové kamene.

Výskyt žlčníkových kameňov

Prítomnosť žlčových kameňov v tomto orgáne je odborne nazývaná cholecystolitiáza. Pojem choledocholitiáza naopak označuje výskyt kameňov v žlčových cestách, pričom oba tieto názvy možno spoločne zahrnúť pod pojem cholelitiáza. Táto choroba patrí medzi najčastejšie choroby zažívacieho traktu. Vyskytuje sa až u 30% našej populácie, pričom častejšie ju nachádzame u žien. Nárast výskytu cholelitiázy v posledných rokoch je spájaný so stále sa zhoršujúcou životosprávou ľudí a predovšetkým potom ich nezdravými stravovacími návykmi. Napriek tomu, že 60 - 80% prípadov tohto ochorenia prebieha bezpríznakovo, predstavuje aj zdanlivo nízke percento jedincov, u ktorých sa príznaky cholelitiázy prejavia, veľký počet pacientov.

Prejavy žlčníkových kameňov

Žlčníkové kamene sa môžu prejavovať pocitmi plnosti v okolí žalúdka, pocitmi tlaku vpravo pod rebrami, neznášanlivosťou tučnej stravy, nevoľnosťami a nadúvaním. Typickým príznakom tejto choroby je však biliárna kolika. K nej dochádza v situácii, keď sa kameň zakliesni v oblasti krčku žlčníka a ten reaguje stiahnutím svaloviny svojej steny. V mieste zakliesnenia sa začnú uvoľňovať látky vyvolávajúce zápal. Vzniká tak veľmi krutá bolesť, ktorá prichádza vo vlnách. Najčastejšie sa objavuje navečer a z oblasti pod pravými rebrami mnohokrát vystreľuje do chrbta až k lopatke. Chorý je nepokojný, bledý, môže mať aj zvýšenú teplotu a byť mierne zažltnutý. Vo viac ako polovici prípadov sprevádza bolesť aj zvracanie, ktoré však neprináša úľavu. Záchvat je často vyvolaný konzumáciou tučných jedál, ale môže byť vyprovokovaný aj telesnou námahou alebo prechladnutím. Medzi hlavné rizikové faktory pre vznik cholecystolitiázy patrí vek, nadváha, ženské pohlavie, etnicita a viacpočetné tehotenstvo.

Druhy žlčníkových kameňov

Žlčníkové kamene sa delia na niekoľko typov podľa zloženia:

  • V rozvinutých krajinách sú najčastejšie cholesterolové žlčníkové kamene. Tie vznikajú v dôsledku zvýšeného množstva tejto látky v žlči, pri poruchách hybnosti žlčníka a žlčových ciest či pôsobením ďalších vplyvov. Obvykle je v žlčníku prítomný len jeden veľký kameň.
  • Pigmentové žlčníkové kamene sa rozlišujú na hnedé, na ktorých vzniku má najväčší podiel infekcia žlčových ciest, a čierne, vznikajúce pri stavoch sprevádzaných nadprodukciou bilirubínu, teda žlčového farbiva. Pigmentové kamene sú vo všeobecnosti menšie než cholesterolové, preto môžu ľahšie prechádzať do žlčovodu, a byť tak príčinou choledocholitiázy. Obvykle sa vyskytujú vo väčšom počte.
  • Zmiešané kamene kombinujú vlastnosti oboch predchádzajúcich typov.

Komplikácie žlčníkových kameňov

Žlčníkové kamene je potrebné včas liečiť, pretože hrozí vznik komplikácií. Tie môžu byť skoré a neskoré.

  • Medzi skoré komplikácie žlčníkových kameňov patrí akútny zápal žlčníka, ktorý sa prejaví bolesťou v oblasti pod pravými rebrami, nauzeou, zvracaním a niekedy aj teplotou. Ďalšou komplikáciou je tzv. hydrops žlčníka. Ide o jeho zväčšenie v dôsledku upchania žlčových ciest. Ďalej môže dôjsť ku vzniku komunikácie medzi žlčníkom a črevom, či k zakliesneniu žlčového kameňa v žlčových cestách.
  • Medzi neskoré komplikácie žlčníkových kameňov patrí chronický zápal žlčníku a zhubný nádor, teda karcinóm žlčníka.

Diagnostika žlčníkových kameňov

Diagnostika žlčníkových kameňov vychádza z podrobnej anamnézy, pri ktorej sa zameriame na problémy pacienta a typické príznaky. K potvrdeniu cholecystolitiázy sa využíva ultrazvukové vyšetrenie, pri ktorom je možné ako zobraziť prítomnosť kameňov, tak zhodnotiť schopnosť stien žlčníka sa správne sťahovať. Stena býva v dôsledku prebiehajúceho zápalu zreteľne rozšírená. V prípade nutnosti podrobnejšieho zobrazenia je možné využitie CT, počítačovej tomografie. Ide o bezbolestné vyšetrenie, pri ktorom sú využité röntgenové lúče prechádzajúce telom pacienta v tunelovom prístroji.

Liečba žlčníkových kameňov

U dlhodobo prebiehajúcej cholecystolitiázy sa odporúča celkové odstránenie žlčníka so žlčníkovými kameňmi pomocou chirurgického zákroku. Dnes je najčastejšie využívaná metóda laparoskopická, pri ktorej sa do brušnej dutiny vstupuje len niekoľkými malými otvormi, ktorá významne znížila riziko tohto zákroku. Liečba nechirurgická, predovšetkým potom opatrenia diétne, sa odporúčajú iba na obdobie po biliárnej kolike.

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+ tens of thousands of negative reviews about you and your website from angry people for aggressive web and email spam
+ lifetime blocking of your hosting account for aggressive web and email spam
+ lifetime blocking of your domain for aggressive web and email spam
+ Thousands of angry complaints from angry people will come to your mail and messengers for sending you a lot of spam
+ complete destruction of your reputation and loss of clients forever
+ for a full recovery from the damage you need tens of thousands of dollars

All of the above will result in blocking your domain and hosting account for life. The price of your peace of mind is 0.5 BTC.

Do you want this?

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How do I do all this to get this result:
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And everyone will not care that it is not you.
2. I’ll send messages to 19,000,000 email addresses and very intrusive advertisements for making money and offer a free iPhone with your website address sk.medixa.org and your contact details.
And then send out abusive messages with the address of your site.
3. I will do aggressive spam on blogs, forums and other sites (in my database there are 35 978 370 sites and 315 900 sites from which you will definitely get a huge amount of abuse) of your site sk.medixa.org.
After such spam, the spamhouse will turn its attention on you and after several abuses your host will be forced to block your account for life.
Your domain registrar will also block your domain permanently.

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If you do not want to receive thousands of complaints from users and your hosting provider, then pay before June 1, 2019.
The price of your peace of mind is 0.5 BTC.
Otherwise, I will send your site through tens of millions of sites that will lead to the blocking of your site for life and you will lose everything and your reputation as well.
But get a reputation as a malicious spammer.

My bitcoin wallet:19ckouUP2E22aJR5BPFdf7jP2oNXR3bezL

26. mája 2019 10:59

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My bitcoin wallet:19ckouUP2E22aJR5BPFdf7jP2oNXR3bezL

Here is a list of what you get if you don’t follow my requirements:
+ abuse spamhouse for aggressive web spam
+ tens of thousands of negative reviews about you and your website from angry people for aggressive web and email spam
+ lifetime blocking of your hosting account for aggressive web and email spam
+ lifetime blocking of your domain for aggressive web and email spam
+ Thousands of angry complaints from angry people will come to your mail and messengers for sending you a lot of spam
+ complete destruction of your reputation and loss of clients forever
+ for a full recovery from the damage you need tens of thousands of dollars

All of the above will result in blocking your domain and hosting account for life. The price of your peace of mind is 0.5 BTC.

Do you want this?

If you do not want the above problems, then before June 1, 2019, you need to send me 0.5 BTC to my Bitcoin wallet: 19ckouUP2E22aJR5BPFdf7jP2oNXR3bezL

How do I do all this to get this result:
1. I will send messages to 33 000 000 sites with contact forms with offensive messages with the address of your site, that is, in this situation, you and the spammer and insult people.
And everyone will not care that it is not you.
2. I’ll send messages to 19,000,000 email addresses and very intrusive advertisements for making money and offer a free iPhone with your website address sk.medixa.org and your contact details.
And then send out abusive messages with the address of your site.
3. I will do aggressive spam on blogs, forums and other sites (in my database there are 35 978 370 sites and 315 900 sites from which you will definitely get a huge amount of abuse) of your site sk.medixa.org.
After such spam, the spamhouse will turn its attention on you and after several abuses your host will be forced to block your account for life.
Your domain registrar will also block your domain permanently.

All of the above will result in blocking your domain and hosting account for life.
If you do not want to receive thousands of complaints from users and your hosting provider, then pay before June 1, 2019.
The price of your peace of mind is 0.5 BTC.
Otherwise, I will send your site through tens of millions of sites that will lead to the blocking of your site for life and you will lose everything and your reputation as well.
But get a reputation as a malicious spammer.

My bitcoin wallet:19ckouUP2E22aJR5BPFdf7jP2oNXR3bezL

26. mája 2019 9:09

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My bitcoin wallet:19ckouUP2E22aJR5BPFdf7jP2oNXR3bezL

Here is a list of what you get if you don’t follow my requirements:
+ abuse spamhouse for aggressive web spam
+ tens of thousands of negative reviews about you and your website from angry people for aggressive web and email spam
+ lifetime blocking of your hosting account for aggressive web and email spam
+ lifetime blocking of your domain for aggressive web and email spam
+ Thousands of angry complaints from angry people will come to your mail and messengers for sending you a lot of spam
+ complete destruction of your reputation and loss of clients forever
+ for a full recovery from the damage you need tens of thousands of dollars

All of the above will result in blocking your domain and hosting account for life. The price of your peace of mind is 0.5 BTC.

Do you want this?

If you do not want the above problems, then before June 1, 2019, you need to send me 0.5 BTC to my Bitcoin wallet: 19ckouUP2E22aJR5BPFdf7jP2oNXR3bezL

How do I do all this to get this result:
1. I will send messages to 33 000 000 sites with contact forms with offensive messages with the address of your site, that is, in this situation, you and the spammer and insult people.
And everyone will not care that it is not you.
2. I’ll send messages to 19,000,000 email addresses and very intrusive advertisements for making money and offer a free iPhone with your website address sk.medixa.org and your contact details.
And then send out abusive messages with the address of your site.
3. I will do aggressive spam on blogs, forums and other sites (in my database there are 35 978 370 sites and 315 900 sites from which you will definitely get a huge amount of abuse) of your site sk.medixa.org.
After such spam, the spamhouse will turn its attention on you and after several abuses your host will be forced to block your account for life.
Your domain registrar will also block your domain permanently.

All of the above will result in blocking your domain and hosting account for life.
If you do not want to receive thousands of complaints from users and your hosting provider, then pay before June 1, 2019.
The price of your peace of mind is 0.5 BTC.
Otherwise, I will send your site through tens of millions of sites that will lead to the blocking of your site for life and you will lose everything and your reputation as well.
But get a reputation as a malicious spammer.

My bitcoin wallet:19ckouUP2E22aJR5BPFdf7jP2oNXR3bezL

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