The Gallstone Elimination Report
Gallstones affect up to 20 of the population in the Western world and the incidence increases with age. They may remain asymptomatic or they may cause serious illness. Pancreatitis is often caused by passage of gallstones. It can be very severe, may become chronic and can impair pancreatic function.
However, the supersaturated solution is unstable and cholesterol may crystallize around a microscopic particle or nidus, such as a bacterial cell. Initially crystals are very small, forming sludge or biliary sand, but they grow by accretion over time. Eighty-five percent of gallstones are cholesterol stones, formed in this way. Ileal disease that interrupts the entero-hepatic circulation of bile salts, increases the risk of gallstone formation. Most gallstones remain in the gallbladder and are asymptomatic, although there is a slightly increased risk of gallbladder cancer, which itself is very rare. Gallstones ejected from the gallbladder, however, may obstruct the bile ducts and are the main cause of symptomatic gallstone disease. A stone in the cystic duct can obstruct the gallbladder, which may then become infected, causing cholecystitis. Impacted stones in the common bile duct cause intrahepatic and extrahepatic biliary obstruction and, if the...
Fenofibrate An antihyperlipidemic used to control the triglyceride and blood fat levels of patients whose blood fats are not controlled by diet. It has proved particularly good for patients at risk for pancreatitis as a result of high levels of fats in their blood. Fenofibrate interacts with several drugs, including anticoagulants, so people taking this drug must warn their physicians about any medications they are already taking. Fenofibrate used by people who have liver, kidney, or gallbladder disease with attention to blood levels of enzymes related to these organs. It is unclear whether
Although the effector cells of AIP have been poorly understood, the activated CD4+ and CD8+ T-cells bearing HLA-DR and CD45RO were increased in the peripheral blood lymphocytes (PBLs) in the patients with AIP in comparison with those in other causes of pancreatitis such as alcoholic or gallstone-related pancreatitis.26 CD4 or CD8 T-cells also predominantly infiltrate in the pancreas tissue over B-cells.19,25 In some patients with AIP, HLA-DR antigens are expressed on the pancreatic duct cells as well as T-cells.9
Alkaline phosphatase Similar forms of this enzyme are found in liver and bone. An elevated alkaline phosphatase level is found in patients with liver disease, particularly conditions such as gallstones that obstruct the flow of bile. Any condition that causes bone to turn over more rapidly, for example a fracture or paget's disease, will also elevate the alkaline phosphatase level. If it is unclear if the source of an elevated alkaline phosphatase level is bone or liver, a bone-specific alkaline phos-phatase can be measured.
Intrapressure of the pancreatic duct is higher than the intrapressure of the biliary tract, the pancreatic juice regurgitates into the biliary tract continuously and the biliary mucosa is continuously susceptible to damage as a result of a continued presence of infected bile and activated pancreatic enzymes. Regurgitated phospholipase A2 of the pancreatic juice activates lisolecithin in the bile, which injures the bile duct and evokes bile duct cancer. This eventually causes cancer to occur in the biliary mucosa and other pathological changes including gallstones (28.5 to 38.1 ) or acute pancreatitis (23.4 to 26.6 ). When PBM is associated with a congenital choledochal cyst,24 bile duct cancer is often seen in the choledochal cyst (15.6 to 36.0 ).25 When PBM is not associated with congenital choledochal cyst, gallbladder carcinoma is sometimes seen due to a condensation of the bile containing pancreatic juice in the gallbladder.26
The great Hippocratic scholar Emile Littre was the first academician to tackle the meaning of this passage. He translated it as, I will not practice surgery for stone I will leave this to people who do that. His translation restricts the scope of the passage to surgery for stone rather than reading it as a general disavowal of surgery, especially surgery for stones. Though linguists do not accept the restrictive translation, many commentators tacitly accept it and narrowly debate the kind of stones that are being referred to. Veatch asserts it was gallstones.6 Wangensteen said they were kidney stones, though Internal Affections describes cutting into the kidney to flush stones out. That treatise described violent pain
There are some toxic agents that cause damage to the exocrine pancreas resulting in acute or chronic pancreatitis or cancer.44 The toxic agents include toxic chemicals (see Chapter 22), therapeutic drugs, hormones, and bile salts. Chemicals toxic to the pancreas included alcohol (see Chapter 15), alloxan, streptozotocin, azaserine, dimethylbenzo a anthracene, ethio-nine, methanol, oleic acid, 4-hydroxyaminoquinoline-1-oxide, beta-oxidized derivatives of dipropylnitrosamine, and chloroform that can cause acute pancreatic injury and death or hyperplasia, metaplasia, and malignant transformation. Toxic therapeutic agents that are known to induce acute pancreatitis include azathioprine, estrogens, furosemide, methyldopa, pen-tamidineprocainamide, sulfonamides, and thiazide diuretics. The immuno-suppressants FK506 and cyclosporine A also inhibit pancreatic secretory response to CCK and cause tissue damage in the exocrine pancreas. CCK and its analog cerulein are also toxic to the exocrine...
The patient denied jaundice, pruritus, and change in appetite, but reported a 6-7-lb weight gain. Additionally, she denied a history of hepatitis and any other liver or gallbladder disease in the past. The patient never smoked, used alcohol, or illicit drugs. There was no history of blood transfusions, tattoos placed, or multiple sexual partners. She had not been recently exposed to anyone with known viral hepatitis. Her family history was positive for hypertension, heart disease, and diabetes mellitus, but negative for liver and biliary tract disease. Her current medications included metformin, glipizide, losartan, metoclo-pramide, and aspirin. She used no over-the-counter medications, including herbal or dietary supplements.
The metabolic syndrome is associated with increased risk of a variety of disease outcomes, including diabetes, peripheral arterial disease (the association with cardiovascular disease is discussed in Chapter 10), fatty liver and non-alcoholic steatohepatosis (discussed in Chapter 11), polycystic ovary syndrome (discussed in Chapter 12), gallstones, asthma, sleep apnoea and selected malignant diseases.
An ultrasonographic scan of the abdomen showed marked ascites with an inhomo-geneous, coarsened liver not containing any intrahepatic masses, an intact gallbladder without gallstones, and an enlarged spleen of 17.5 cm. Seven liters of peritoneal fluid was drained and the patient received albumin (42 g) after the procedure. Analysis of the fluid demonstrated a total leukocyte count of 75 x 103 mL (75 x 109 L), 20 of which were granulocytes total protein, 0.9g dL (9 g L) albumin,
Despite treatment, the patient continued to have hot flashes, and one month later developed postprandial upper right quadrant pain, occasionally accompanied by abdominal distension and what she referred to as excessive flatulence. She was referred to a gastroenterologist, who performed an abdominal ultrasound that revealed a 5-mm mass embedded in the wall of the gallbladder, thought to represent either a polyp or a gallstone. Despite normal liver function tests, the patient elected to undergo a laparoscopic cholecys-tectomy. Pathology on the gallbladder revealed a 3-mm stone.
A duodenoscope with a sideways-facing tip allows visualization and cannulation of the ampulla of Vater. Contrast material can then be injected into the pancreatic and biliary ducts and X-ray images taken. Close-up ultrasound images can be obtained by inserting compact ultrasound probes into the duct. Cannulae and instruments can be introduced to obtain brushings or biopsies, remove gallstones, and dilate strictures. The sphincter of Oddi may be cut (sphincterotomy), allowing gallstones to pass spontaneously.
Bezoar stones were stomach or intestinal calculi made of calcium phosphate which deposited around a gallstone or other foreign material. Goats, cows, and apes were their sources. The stones were used in multiple ways but always to prevent or treat poisoning. It is, perhaps, not surprising that man would bestow some measure of reverence on an object which arose from the body in an unusual manner and endow it with supernatural characteristics.
Acute pancreatitis is a serious, potentially life-threatening illness. The most common causes are excess alcohol ingestion and passage of gallstones through the ampulla of Vater (see Chapter 40). Less frequent causes include various drugs, abdominal trauma and viral infection. The inflamed pancreas releases enzymes into the circulation and acute pancreatitis is a systemic illness, affecting the whole body. Pancreatic lipases release fatty acids that interact with calcium to form insoluble calcium-fatty acyl salts, potentially lowering the concentration of calcium in the circulation to dangerous levels. A dramatic rise in the serum lipase or amylase level helps to diagnose acute pancreatitis.
Ultrasound scanning (USS) is particularly useful for examining the liver and gallbladder. USS detects 90 of gallstones (compared to 10 detected by X-rays) and can also be used to evaluate the texture of the liver, the thickness of the gallbladder wall and the calibre of bile ducts. USS can also image the pancreas although overlying bowel gas makes this unreliable. Free fluid in the peritoneum, or ascites, is also readily demonstrated by USS. It is less helpful for examining air-filled structures, such as the intestinal tract.
Gallstones, which cause acute biliary pancreatitis and are especially common in females Gallstones are extremely common in developed countries, but the prevalence of gallstones varies widely throughout the world. They are more common in females than in males and become more common with increasing age. Gallstones form in the gallbladder, and when they are confined to this organ, they cause acute cholecystitis, rather than pancreatitis. But severe pancreatitis can occur if gallstones enter the common bile duct and obstruct the opening of the pancreatic duct. Fortunately, only a small percentage of patients with gallstone disease, perhaps 1 or 2 , ever develop pancreatitis. Small gallstones are often found in patients who develop biliary pancreatitis. What are some of the environmental factors leading to the formation of gallstones Numerous studies have determined that the major risk factor causing cholelithiasis is obesity. Both male and females who are overweight have an increased risk...
Get Rid of Gallstones Naturally
One of the main home remedies that you need to follow to prevent gallstones is a healthy lifestyle. You need to maintain a healthy body weight to prevent gallstones. The following are the best home remedies that will help you to treat and prevent gallstones.