Los cálculos biliares son formaciones de colesterol y/o de sales (cálculos pigmentarios) que se producen en los conductos biliares. Cuando se localizan en la vesícula hablamos de colelitiasis biliar, cuyo síntoma más característico es un dolor agudo en el abdomen que puede irradiarse a la espalda y que se conoce como cólico biliar. Una dieta y un estilo de vida adecuados ayudan a prevenirlos.
Aproximadamente el 12% de la población sufre colelitiasis, un trastorno caracterizado por la presencia de cálculos biliares o piedras en la vesícula, un pequeño saco muscular de almacenamiento, en forma de pera, que contiene la bilis y que está interconectado con el hígado mediante unos conductos llamados vías biliares. Según explican desde la Fundación Española del Aparato Digestivo (FEAD), aunque el síntoma más característico es un dolor agudo e intenso localizado en el cuadrante superior derecho del abdomen (cólico biliar), que aumenta de forma progresiva y puede alternar con pequeños periodos sin dolor, sin embargo, sólo un 25% de las personas afectadas desarrolla síntomas. En algunas ocasiones el dolor puede irradiarse hacia atrás, hacia la espalda, como si se tratase de un cinturón.
Piedras en la vesícula. Los síntomas
- Además del dolor agudo (cólico biliar) y que se irradia a la espalda, pueden aparecer náuseas y vómitos.
- La presencia de fiebre y escalofríos puede hacer sospechar de una inflamación de la vesícula (colecistitis).
- Si se producen cambios en el color de la orina (oscura, tipo cola), de las heces (blanquecinas-arcillosas) o en el tono de la piel (color amarillo de piel) se debe sospechar la obstrucción de la vía biliar por la salida de alguno de las litiasis a la vía biliar (coledocolitiasis).
Colesterol y sales biliares
Estos cálculos suelen ser de colesterol y se producen por alteraciones en el metabolismo que dan lugar a su formación. También pueden estar formados por sales biliares (cálculos pigmentarios), o por una mezcla de ambos. Según explican desde FEAD, existen muchas causas que lo favorecen, como la edad, sexo femenino, predisposición genética, pérdida rápida de peso, obesidad, enfermedades hepáticas, medicamentos, dietas ricas en grasas y calorías, etc. La primera prueba a realizar a un paciente con síntomas de cólico biliar es una ecografía abdominal, una prueba sencilla que permitirá ver el número de cálculos, así como su tamaño y composición, además de su localización en la vesícula y/o en los conductos biliares (coledocolitiasis). Otras pruebas complementarias que pueden dar alguna pista son el recuento de glóbulos blancos, bilirrubina, transaminasas, amilasa y orina.
Haber presentado un episodio de dolor aumenta el riesgo de que vuelva a repetirse (aproximadamente un 38% de recurrencias al año).
Tratamientos no quirúrgicos
Durante el episodio agudo de cólico biliar se aconseja el reposo digestivo, calor local y analgesia. El uso de antiinflamatorios (AINEs), además de aliviar los síntomas, puede evitar la progresión hacia una colecistitis aguda. También se pueden combinar con el uso de analgésicos tipo paracetamol o metamizol. Los medicamentos a base de ácidos biliares pretenden revertir la sobresaturación biliar de colesterol, que es el proceso que provoca la formación de cálculos, pero aunque son fármacos habitualmente bien tolerados, no están exentos de efectos adversos, principalmente diarrea y en escasas ocasiones elevación de transaminasas, además de ser sólo útiles en un reducido número de pacientes, mostrando una alta tasa de recidiva. Por último, la litotricia es una técnica que utiliza ondas ultrasónicas para fragmentar las litiasis o cálculos en pequeños fragmentos que se expulsan de manera natural por la vía biliar. Esta técnica está limitada a un reducido número de pacientes y tiene también una elevada tasa de recidiva de las litiasis. Este tratamiento se suele utilizar en combinación con los ácidos biliares para aumentar su eficacia y está contraindicado en embarazadas y en pacientes anticoagulados.
Cuando quitar la vesícula
La mayoría de los pacientes (sobre el 80%) con una colelitiasis asintomática y vía biliar normal permanecen asintomáticos durante toda la vida, por lo que no está recomendada la realización de ningún tratamiento médico o quirúrgico especifico, ni tampoco un seguimiento clínico especial. Sin embargo, cuando se produce una colelitiasis biliar sintomática, los médicos pueden valorar quitar la vesícula en quirófano mediante una técnica conocida como colecistectomía, y que puede ser abierta o convencional y laparoscópica.
No a…
- El exceso de grasa puede provocar un cólico biliar, por lo que están desaconsejados los embutidos y carnes grasas (cordero, cerdo).
- La leche entera, mantequilla, margarina, natas y cremas.
- Chocolates y pasteles.
- Huevos.
- Aceitunas.
- Frutos secos (nueces, avellanas, almendras, cacahuetes, etc.).
- Aceite y platos precocinados.
Sí a…
- Lácteos y derivados semi o desnatados. Quesos frescos y bajos en grasas.
- Patatas, arroz, sémola, pasta, pan, cereales del desayuno, galletas “tipo María”, legumbres trituradas y pasadas por el pasapuré.
- Verduras y hortalizas cocidas y sin piel.
- Carnes magras (lomo, solomillo de cerdo o ternera), aves sin piel, conejo, pescados blancos, jamón cocido, etc.
- Frutas cocidas en compota, en conserva, muy maduras, sin piel, zumos de frutas no ácidas.
- Azúcar, miel, confitura sin semillas.
- Agua, infusiones, caldos desgrasados, batidos realizados con leche o yogur desnatados.
- Aceite de oliva y girasol en cantidades moderadas.
7 reglas ¡YA!
- Sigue una dieta saludable y variada.
- Evita las comidas abundantes. Come poca cantidad y varias veces al día; lo ideal es repartir las comidas en 5-6 tomas (desayuno, media mañana, comida, merienda, cena y algo antes de acostarse).
- Come despacio y en un ambiente tranquilo. Mastica bien.
- Reposa sentado hasta media hora después de las comidas principales.
- Utiliza técnicas de cocinado sencillas (hervidos, en su jugo, plancha, vapor, horno) y evita los fritos, rebozados, empanados, salsas, guisos y en general todas aquellas cocciones que lleven muchas grasa y aceite.
- En el caso de padecer una colelitiasis sintomática, toma líquidos y agua en pequeñas cantidades (evitando los zumos y las bebidas gaseosas), siempre fuera de las comidas y en cantidad no inferior a 2 litros al día.
- También en el caso de presentar síntomas, hay que evitar alimentos estimulantes (café, refrescos de cola, alcohol) y alimentos que no se toleren bien de forma repetida. Las legumbres pueden producir “gases”. Si no se toleran los cereales integrales, es mejor sustituirlos por refinados.
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