O que é colelitíase?

A colelitíase é mais conhecida como a pedra na vesícula e acontece quando cálculos (pedras) se formam neste órgão ou nos ductos biliares.

Vesícula biliar é um pequeno órgão em formato de saco que fica logo abaixo do fígado. Ela armazena a bile, um líquido que é despejado no intestino para ajudar na digestão de gorduras que entram no corpo através da alimentação.

Apesar de ser chamada de pedra na vesícula, a colelitíase pode formar cálculos fora do órgão, nos ductos que levam a bile do fígado, onde é produzida, até o órgão que a armazena e para o intestino.

Estes representam apenas 10% dos casos, portanto o mais comum (90% das vezes) é que as pedras se formem realmente dentro da vesícula, daí o nome.

A bile é formada por diversas substâncias como água, cálcio, colesterol e pigmentos como a bilirrubina, que dá sua cor amarelada. Ela é produzida pelo fígado e levada para a vesícula, onde o órgão a deixa concentrada, absorvendo a água.

A vesícula é capaz de armazenar em torno de 50 mL de bile, que digere a gordura e anula ácidos dos alimentos no duodeno, a porção inicial do intestino delgado.

A maior parte dos sais usados na bile são reaproveitados pelo corpo.

Em algumas ocasiões, esses materiais concentrados podem se solidificar, formando pequenas pedras dentro da vesícula ou nos dutos que a conectam com outros órgãos.

SINTOMAS

Muitas vezes a colelitíase não apresenta sintomas. Isso acontece porque as pedras podem ser muito poucas e pequenas para que produzam sinais de sua presença.

Entretanto, quando existem pedras grandes, muitas pedras pequenas ou quando alguma delas entra no ducto biliar e o bloqueia, os sintomas aparecem.

Cólica biliar

Os cálculos biliares podem causar dor forte quando bloqueiam o caminho da bile, causando um aumento da pressão interior da vesícula biliar, que se contrai tentando empurrar a bile para fora. A cólica biliar costuma ficar no lado direito do corpo.

Esta dor costuma se iniciar de maneira súbita e intensa após a ingestão de gordura e passa no decorrer da hora seguinte, aos poucos.

Dor abdominal no lado direito

O inchaço do órgão pode causar dor que se espalha pelo abdômen a partir do lado direito dele, onde fica a vesícula. Este sintoma só aparece nos casos mais agudos da doença e pode ser acompanhado de febre, calafrios e dores de cabeça.

Icterícia

A icterícia se instala quando há acúmulo de bilirrubina nos tecidos, deixando a pessoa com uma coloração amarelada. No caso da colelitíase, ela aparece quando um cálculo biliar bloqueia o ducto colédoco, que leva a bile para a vesícula, fazendo com que a bilirrubina volte para o fígado e seja absorvida pelo sangue.

Náusea e vômitos
Os problemas causados pelos cálculos podem causar náuseas e vômitos.

Inchaço abdominal
Devido aos problemas digestivos causados pela falta da bile no intestino, pode haver inchaço do abdômen devido a gases. Além disso, a vesícula também pode ficar inchada.

Fezes claras e urina escura

A bilirrubina é a substância responsável pela coloração das fezes. Quando algo — como um cálculo — a impede de chegar ao intestino, as fezes podem ficar claras. Da mesma forma, quando ela se acumula no corpo por não poder ir ao intestino, pode ser eliminada pela urina, deixando-a escura.

Como é feito o diagnóstico?

Os sintomas podem levantar a suspeita da condição, mas apenas o exame de imagem é capaz de confirmar o diagnóstico. O médico que faz este diagnóstico é o gastroenterologista, responsável pelos cuidados do sistema digestivo.

Ultrassonografia
O exame de ultrassom possui uma eficácia elevada, conseguindo identificar de 95% a 99% dos casos de cálculos biliares, mesmo quando elas estão pequenas e não apresentam sintomas. Além disso, existe neste exame a vantagem de ele não ser caro e nem invasivo. Não é necessário contraste, anestesia e nem existem efeitos colaterais.

Tomografia computadorizada
Tão efetiva quanto a ultrassonografia, a tomografia computadorizada também pode encontrar os cálculos biliares. Este exame utiliza raio-X para criar uma imagem precisa do interior do corpo.

A tomografia computadorizada é diferente da radiografia (popular raio-X) por fazer diversas imagens que são enviadas para um computador, que as une de maneira a mostrar diversos detalhes que poderiam escapar com o raio-X comum.

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