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“НАШЕ ЖИТТЯ”, СІЧЕНЬ 2009 36 GALLSTONES by Ihor Magun, M.D., F.A.C.P. With a prevalence in at least 20 percent of women over the age of forty, compared to 8 percent of men, gallstone disease presents as a common medical/surgical problem. Sixteen to twenty million people have this condition, with an incidence of approximately one million new cases per year. The presence of stones in medical jargon bears the name cholelithiasis ; inflammation of the gallbladder is labeled as cholecystitis . So what are gallstones, and exactly why do they form? The explanation has to begin with a brief description of the part of the human anatomy called the gallbladder. The gallbladder is a small, pear- shaped muscular sac located under the right lobe of the liver (on the right side of the body). It serves as a storage organ for bile produced in the liver. Bile is necessary for digestion of fats in the first section of the intestine. This fluid is actually a delicate balance of three substances: cholesterol, bile acids, and bile-salt lecithin. Cholesterol is water-insoluble and requires another lipid to liquify it. When the cholesterol content of bile acid and bile salt-lecithin are not in a stable proportion, stones form. Gallstones are crystalline structures, and there are three major types. The first two are cholesterol and mixed stones, which account for 80 percent of the total, and pigment stones, which account for the remaining 20 percent. The most important cause of gallstones is increased biliary secretion of cholesterol. Hyper- cholesterolemia is a metabolic phenomenon occur- ring in diabetes, obesity, and pregnancy but can also be found in patients with hypothyroidism and in individuals who experience rapid weight loss. Another cause is spasms that lead to stagnation of bile in the gallbladder itself. A third cause is inflammation of the gallbladder brought on by an infection. The consequences of gallstone formation depend upon the location, type of stone, and number of stones. Large stones characteristically cause inflammation, whereas multiple small stones (this can sometimes be as high as 100 stones) produce a blockage, which leads to pain and jaundice. The classic symptom is constant pain in the right upper abdominal area. The pain rapidly in- creases in strength and intensity. Pain can occur at the base of the shoulder blades or at the right shoulder. There may also be nausea and vomiting, or pain following a fatty meal. Other symptoms include sweating, chills, fever, and clay colored stools, although some stones are asymptomatic. Diagnosis is relatively simple. Ultrasono- graphy is the gold standard. It is very accurate and can identify stones as small as two millimeters in size. The currently preferred treatment involves a minimally invasive surgical procedure called the laparoscopic cholecystectomy. There is a markedly short hospital stay; in most cases, recovery comes within a week or so. Some individuals, however, may require the traditional approach, an open cholecystectomy, with a six week recovery period. Gallstone disease discovered in an asymptomatic individual for an unrelated problem usually does not warrant treatment. What can be done to prevent stone formation? The answer is basic and applies to many other health matters: weight management, gradual weight loss, good fiber diet, and avoidance of high fat diets. Our Life Press Fund $10 from Romana U. Czyzyk, Oksana Mostovych, Martha J. Wiegand, Lubomyra Yoldas, Ulana Diaczuk $20 from Taissa Meleshko, Irena Ostapiuk, Ludmyla Doroshenko-Slobidsky $25 from Tatiana B. Durbak $50 from Marta Mulyk-Baxer Видання C оюзу Українок A мерики - перевидано в електронному форматі в 2012 році . A рхів C У A - Ню Йорк , Н . Й . C Ш A.
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