Los cálculos de vesícula ¿Son muy frecuentes?

Publicado por Santy Bevilacqua en

                 Los cálculos de la vesícula o Litiasis Vesicular es una enfermedad muy frecuente en muchos países del mundo y también en el nuestro donde se estima que aproximadamente el 25% de la población femenina mayor de 40 años  y el 10-15% de la masculina durante algún período de su vida hacen cálculos en la vesícula. Siendo mas frecuente en mujeres en edad media, con cierto grado de obesidad y que han tenido varios hijos. La mayoría de los cálculos están compuestos principalmente de Colesterol y Bilirrubina de Calcio en proporciones variables. En cuanto a las  causas que lo originan, se piensa que juega un papel muy importante la composición de la Bilis, así se sabe que la misma contiene predominantemente de Colesterol, Sales Biliares y Lecitina los cuales se encuentran en un balance o equilibrio permanente, y cuando por alguna razón se pierde ese balance se produce una precipitación de microcristales de Colesterol (principalmente)  que servirán de núcleo para la formación del futuro cálculo.

               La Litiasis Vesicular se caracteriza por  dolor tipo cólico en el lado derecho y superior del abdomen que se irradia hacia la espalda o entre los dos omóplatos, cuando se ingieren granos o alimentos grasosos, además sensación de llenura, distensión abdominal, pesadez en la parte superior del abdomen y gases abundantes.

                En la actualidad el procedimiento diagnóstico de elección es la Ecosonografía  de la Vesícula que tiene una elevada efectividad en el diagnóstico de la Litiasis Vesicular y además de ser un procedimiento no invasivo,  esta disponible en la mayoría de los Hospitales y Clínicas de nuestro país.

                 Siendo una enfermedad tan común como lo es, se ha especulado muchísimo en cuanto al tratamiento, existiendo gran cantidad de remedios y pócimas caseras para la "expulsión de los cálculos" que muchas veces son peligrosas, ya que a menudo se trata de potentes estimuladores del vaciamiento vesicular que van a provocar la migración de cálculos desde el interior de la vesícula hacia las Vías Biliares lo cual provocaría ictericia (coloración amarilla de piel y mucosas), coluria (orinas obscuras) e hipocótila (color pálido de las heces)  y también infección secundaria de las vías biliares (Colangitis), en estos pacientes.

                  El tratamiento aceptado durante mucho tiempo para la Litiasis Vesicular es quirúrgico y se trata de la Colecistectomía Total  (extracción completa de la vesícula y su contenido) desde hace varias décadas la Colecistectomía Laparoscópica, que es la extracción de la vesicular por métodos laparoscópicos, se ha convertido en el procedimiento terapéutico por elección  por su seguridad, rapidez y la rápida recuperación de los pacientes posterior a ella, aunque en el mundo se ha experimentado con otros métodos terapéuticos como por ejemplo: el uso de medicamentos para lograr la "fusión" de los cálculos pero estos productos tiene muchos inconvenientes ya que son muy costosos, y con muchos efectos colaterales, además deben usarse por tiempo prolongado y al poco tiempo de suspenderse, reaparecen los cálculos, lo que hace que su uso se halla abandonado en la mayor parte del mundo. El otro procedimiento terapéutico que se ha utilizado con éxito relativo es la Litotripsia Extracorpórea, que es la destrucción de los cálculos con Onda de Choque (similar a la usada para el Ultrasonido pero con distinta longitud de onda) la cual convierte los cálculos en pequeños fragmentos, muy usado para los cálculos renales, en la actualidad prácticamente se  ha abandonado su uso para los cálculos de la vesícula.

Autor:

Dr Raul Arocha E.
Gastroenterólogo

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