Kim Kardashian gave birth to a baby girl on Saturday, but just five days before delivering her first child, she was lounging poolside. Kim and her boyfriend, Kanye West, may have welcomed their daughter a little earlier than her expected July arrival, but Kim seems to be enjoying motherhood already. The accuracy of diagnostic results has improved significantly with advances in ultrasonography, CT, MRI, and scintigraphy. Preliminary results of a large trial have shown that single-incision laparoscopic cholecystectomy (SILC) is safe, and, although it requires more operating time, cosmetic satisfaction was higher among patients who had SILC compared to those who underwent traditional (4-port) laparoscopic surgery. A new investigational procedure called Natural Orifice Translumenal Endoscopic Surgery (NOTES) is enabling surgeons to remove the gallbladder through the mouth, stomach, rectum or vagina.
The American Society for Gastrointestinal Endoscopy has published several guidelines for the endoscopic treatment of gallbladder and bile duct stones.
Gallstones are small, hard deposits that form in the gallbladder, a sac-like organ that lies under the liver in the upper right side of the abdomen.
The formation of gallstones is a complex process that starts with bile, a fluid composed mostly of water, bile salts, lecithin (a fat known as a phospholipid), and cholesterol. The gallbladder serves as a reservoir until bile is needed in the small intestine to digest fats. This part of the digestive process enables the emulsified fat, along with important fat-absorbable nutrients (such as vitamins A, D, E, and K), to pass through the intestinal lining and enter the bloodstream. Cholesterol is not very soluble, so in order to remain suspended in fluid it must be transported within clusters of bile salts called micelles. If the imbalance worsens, cholesterol crystals form (a condition called supersaturation), which can eventually form gallstones. Supersaturation and cholelithiasis can occur as a result of various abnormalities, although the cause is not entirely clear. The cells lining the gallbladder may not be able to efficiently absorb cholesterol and fat from bile.
Gallbladder disease can occur without stones, a condition called acalculous gallbladder disease.
Acute acalculous gallbladder disease usually occurs in patients who are very ill from other disorders. Chronic acalculous gallbladder disease (also called biliary dyskinesia) appears to be caused by muscle defects or other problems in the gallbladder, which interfere with the natural contractions needed to empty the sac. The mildest and most common symptom of gallbladder disease is intermittent pain called biliary colic, which occurs either in the mid- or the right portion of the upper abdomen. The primary symptom is typically a steady gripping or gnawing pain in the upper right abdomen near the rib cage, which can be severe and can radiate to the upper back. Changing position, taking over-the-counter pain relievers, and passing gas do not relieve the symptoms.
The episodes typically occur at the same time of day, but less frequently than once a week. Digestive complaints, such as belching, feeling unusually full after meals, bloating, heartburn (burning feeling behind the breast bone), or regurgitation (acid back-up in the food pipe), are not likely to be caused by gallbladder disease.
Between 1 - 3% of people with symptomatic gallstones develop inflammation in the gallbladder (acute cholecystitis), which occurs when stones or sludge block the duct. Pain may also radiate to the back or occur under the shoulder blades, behind the breast bone, or on the left side. About a third of patients have fever and chills, which do not occur with uncomplicated biliary colic. Chronic gallbladder disease (chronic cholecystitis) involves gallstones and mild inflammation. Complaints of gas, nausea, and abdominal discomfort after meals; these are the most common symptoms, but they may be vague and difficult to distinguish from similar complaints in people who do not have gallbladder disease. As in acute cholecystitis, patients who have these symptoms should seek medical help immediately. In most cases of obstruction, the stones block the cystic duct, which leads from the gallbladder to the common bile duct.
About 10% of patients with symptomatic gallstones also have stones that pass into and obstruct the common bile duct (choledocholithiasis).
The most serious complication of acute cholecystitis is infection, which develops in about 20% of cases. Research shows that survival rates for gallbladder cancer are on the rise, although the death rate remains high because many people are diagnosed when the cancer is already at a late stage. Because gallstones are related to diet, particularly fat intake, the incidence of gallstones varies widely among nations and regions. Defects in transport proteins involved in biliary lipid secretion appear to predispose certain people to gallstone disease, but this alone many not be sufficient to create gallstones.
People with diabetes are at higher risk for gallstones and have a higher-than-average risk for acalculous gallbladder disease (without stones). Metabolic syndrome is a cluster of conditions that includes obesity (especially belly fat), low HDL (good) cholesterol, high triglycerides, high blood pressure, and high blood sugar. Although gallstones are formed from the supersaturation of cholesterol in the bile, high total cholesterol levels themselves are not necessarily associated with gallstones.
Unfortunately, some fibrates (drugs used to correct these conditions) actually increase the risk for gallstones by increasing the amount of cholesterol secreted into the bile.
Maintaining a normal weight and avoiding rapid weight loss are the keys to reducing the risk of gallstones. Although it would be reasonable to believe that drugs used to lower cholesterol would protect against gallstones, most evidence has found no gallstone protection from these drugs. The challenge in diagnosing gallstones is to verify that abdominal pain is caused by stones and not by some other condition. In patients with abdominal pain, causes other than gallstones are usually responsible if the pain lasts less than 15 minutes, frequently comes and goes, or is not severe enough to limit activities. Blood tests showing high levels of pancreatic enzymes (amylase and lipase) usually indicate a diagnosis of pancreatitis. In patients with known gallstones, the doctor can often diagnose acute cholecystitis (gallbladder inflammation) based on classic symptoms (constant and severe pain in the upper right part of the abdomen). Blood tests are usually normal in people with simple biliary colic or chronic cholecystitis. Bilirubin and the enzyme alkaline phosphatase are usually elevated in acute cholecystitis, and especially in choledocholithiasis (common bile duct stones). Levels of liver enzymes known as aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are elevated when common bile duct stones are present. Ultrasound does not appear to be very useful for identifying cholecystitis in patients who have symptoms but do not have gallstones.
Ultrasound is also not as accurate for identifying common bile duct stones or imaging the cystic duct. Magnetic Resonance Cholangiography (MRCI), or Magnetic Resonance Cholangiopancreatography (MRCP).
Advances in technology have made ultrasonography, CT, and MRI the primary imaging tests for suspected gallbladder disease. In oral cholecystography, the patient takes a tablet containing a dye the night before the test. In cholangiography, a dye is injected into the bile duct and x-rays are used to view the duct.
The patient lies on a table under a scanning camera, which detects gamma (radioactive) rays emitted by the dye as it passes from the liver into the gallbladder. The test can take up to 2 hours, because each image takes about a minute, and images are taken every 5 - 15 minutes.
If the dye does not enter the gallbladder, the cystic duct is obstructed, indicating acute cholecystitis.
Occasionally, the scan gives false positive results (detecting acute cholecystitis in people who do not have the condition). However, this technique is invasive and carries a risk for complications, including pancreatitis. Acute pain from gallstones and gallbladder disease is usually treated in the hospital, where diagnostic procedures are performed to rule out other conditions and complications. Guidelines from the American College of Physicians state that when a person has no symptoms, the risks of both surgical and nonsurgical treatments for gallstones outweigh the benefits. Very small gallstones (smaller than 5 mm) may increase the risk for acute pancreatitis, a serious condition. There are some minor risks with expectant management for people who do not have symptoms or who are at low risk.
The slight risk of developing gallbladder cancer might encourage young adults who do not have symptoms to have their gallbladder removed.
Gallstones are the most common cause for emergency room and hospital admissions of patients with severe abdominal pain. Common bile duct stones pose a high risk for complications and nearly always warrant treatment.
In the past, when common bile duct stones were suspected, the approach was open surgery (open cholecystectomy) and surgical exploration of the common bile duct.
Endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (ES) is now the most frequently used procedure for detecting and managing common bile duct stones.
Laparoscopic cholecystectomy has taken a secondary role in the detection and removal of common bile duct stones.
Oral drugs used to dissolve gallstones and lithotripsy (alone or in combination with other drugs) gained popularity in the 1990s. HNF-4α controlling many genes involved in liver function such as the GLUT2 and L-PK genes. Evidence on the mode of action of metformin shows that it improves insulin sensitivity by increasing insulin receptor tyrosine kinase activity and enhancing glycogen synthesis in hepatocytes, and by increasing recruitment and transport of GLUT4 transporters to the plasma membrane in adipose tissue. In addition to its effects on hepatic glucose and lipid homeostasis and adipose tissue lipid homeostasis, metformin exerts effects in the pancreas, vascular endothelial cells, and in cancer cells.
When you hear the word insulin you may think of a drug taken by people who have diabetes either type 1 or type 2. Yes this is true, but what you may not know that insulin is already one of hormones secreted by your body. When you eat your body breaks down the food into the smallest and simplest form which is glucose that travels within your blood stream to provide cells with energy. So for glucose to get into the cells , it needs insulin hormone, when insulin arrives it signals the cells to activate glucose transporters. Onset which is the length of time before insulin reaches the bloodstream and begins its intended action. Peak time which is the time during which insulin is at its maximum strength in terms of lowering blood glucose levels. If the syringe needle is injected too deep and reached the muscle, the insulin will be absorbed too fast as all the administered dose will move Quickly into the blood stream .
Hint : The fastest absorption rates of Insulin is from the abdomen , followed by the arms, then the thighs, and finally the buttocks. Before performing any kind of injection make sure you properly wash you hands with soap and warm water . Blood sugar – wikipedia, the free encyclopedia, The blood sugar concentration or blood glucose level is the amount of glucose (sugar) present in the blood of a human or animal. Blood glucose monitoring – wikipedia, the free encyclopedia, Blood glucose monitoring is a way of testing the concentration of glucose in the blood . High and low blood sugar symptoms – youtube, It can be important to recognise the difference between low and high blood sugar symptoms. Hyperglycemia: facts on symptoms, signs and treatment, Hyperglycemia is an abnormally high blood glucose (blood sugar) level. Kim showed off her pregnant stomach in a skimpy bikini while hanging out at a spa in LA with friends, including Robin Antin and makeup artist Joyce Bonelli. Ultrasonography has emerged as the primary diagnostic test in suspected gallbladder disease due to its availability, high accuracy, and safety.
The first two transoral and transvaginal cholecystectomies in the NOTES clinical trials were recently performed in the U.S. It is first produced by the liver and then secreted through tiny channels that eventually lead into a larger tube called the common bile duct, which leads to the small intestine. Most flows into the gallbladder through the cystic duct, which is a side branch off the common bile duct.


Here, most of the fluid is removed from the bile (about 2 - 5 cups a day), leaving a few tablespoons of concentrated bile.
This need is signaled by a hormone called cholecystokinin, which is released when food enters the small intestine. The force of the contraction propels the bile down the common bile duct and into the small intestine, where it emulsifies (breaks down) fatty molecules. Pigment stones (black or brown) are also very common and account for the remaining 30% of stones.
Although cholesterol makes up only 5% of bile, about three-fourths of the gallstones found in the US population are formed from cholesterol. If there is an imbalance between these bile salts and cholesterol, then the bile fluid turns to sludge. Bilirubin is a substance normally formed by the breakdown of hemoglobin in the red blood cells.
They contain more cholesterol and calcium than black pigment stones and are more likely to occur in the bile ducts. In most cases, common bile duct stones originally form in the gallbladder and pass into the common duct. This refers to a condition in which a person has symptoms of gallbladder stones, yet there is no evidence of stones in the gallbladder or biliary tract. There is a very small (2%) chance of developing pain during the first 10 years after gallstones form. If it persists beyond this point, acute cholecystitis or more serious conditions may be present. Large or fatty meals can trigger the pain, but it usually occurs several hours after eating and often awakens the patient during the night.
Conditions that may cause these symptoms include peptic ulcer, gastroesophageal reflux disease, or indigestion of unknown cause. Acute cholecystitis can progress to gangrene or perforation of the gallbladder if left untreated. This can cause pain (biliary colic), infection and inflammation (acute cholecystitis), or both.
It is extremely dangerous and life threatening if it spreads to other parts of the body (a condition called septicemia), and surgery is often required. If acute cholecystitis is untreated and becomes very severe, inflammation can cause abscesses. An estimated 10% of acute cholecystitis cases result in a perforated gallbladder, which is a life-threatening condition.
In some cases, the inflamed gallbladder adheres to and perforates nearby organs, such as the small intestine. Common bile duct stones are responsible for most cases of pancreatitis (inflammation of the pancreas), a condition that can be life threatening. There is a strong association between gallbladder cancer and cholelithiasis, chronic cholecystitis, and inflammation. When the cancer is caught at an early stage and has not spread beyond the mucosa (inner lining), removing the gallbladder can cure many people with the disease. Certain conditions in the gallbladder, however, contribute to a higher-than-average risk for this cancer.
Primary sclerosing cholangitis is a rare disease that causes inflammation and scarring in the bile duct. With this rare condition, which is present at birth (congenital), the junction of the common bile duct and main pancreatic duct is located outside the wall of the small intestine and forms a long channel between the two ducts. Gallbladders are referred to as porcelain when their walls have become so calcified (covered in calcium deposits) that they look like porcelain on an x-ray.
However, only 1 - 3% of the population complains of symptoms during the course of a year, and fewer than half of these people have symptoms that return.
Pregnancy increases the risk for gallstones, and pregnant women with stones are more likely to develop symptoms than women who are not pregnant. Several large studies have shown that the use of hormone replacement therapy (HRT) doubles or triples the risk for gallstones, hospitalization for gallbladder disease, or gallbladder surgery. Because most cases do not have symptoms, however, the rates may be underestimated in elderly men. For example, Hispanics and Northern Europeans have a higher risk for gallstones than do people of Asian and African descent. This gene controls a cholesterol pump that transports cholesterol from the liver to the bile duct. Studies indicate that the disease is complex and may result from the interaction between genetics and environment. Gallbladder disease may progress more rapidly in patients with diabetes, who tend to have worse infections. Rapid weight loss or cycling (dieting and then putting weight back on) further increases cholesterol production in the liver, which results in supersaturation and an increased risk for gallstones.
The risk increases proportionately with dramatic weight changes as well as with frequent weight cycling. Patients who have either Roux-en-Y or laparoscopic banding bariatric surgery are at increased risk for gallstones. Gallstone formation is associated with low levels of "good" HDL cholesterol and high triglyceride levels. Prolonged intravenous feeding reduces the flow of bile and increases the risk for gallstones. Crohn's disease, an inflammatory bowel disorder, leads to poor reabsorption of bile salts from the digestive tract and substantially increases the risk of gallbladder disease. Chronic hemolytic anemia, including sickle cell anemia, increases the risk for pigment gallstones.
High consumption of heme iron, the type of iron found in meat and seafood, has been shown to lead to gallstone formation in men. Although fats (particularly saturated fats found in meats, butter, and other animal products) have been associated with gallstone attacks, some studies have found a lower risk for gallstones in people who consume foods containing monounsaturated fats (found in olive and canola oils) or omega-3 fatty acids (found in canola, flaxseed, and fish oil).
Studies suggest that people may be able to reduce their risk of gallstones by eating more nuts (peanuts and tree nuts, such as walnuts and almonds). People who eat a lot of fruits and vegetables may have a lower risk of developing symptomatic gallstones that require gallbladder removal.
Taking the medication ursodiol (also called ursodeoxycholic acid, or Actigall) during weight loss may reduce the risk for people who are very overweight and need to lose weight quickly. Irritable bowel syndrome (IBS) has some of the same symptoms as gallbladder disease, including difficulty digesting fatty foods.
It is sometimes difficult to differentiate between pancreatitis and acute cholecystitis, but a correct diagnosis is critical, because treatment is very different.
Elevated levels of the liver enzyme alanine aminotransferase (ALT) are helpful in identifying gallstone pancreatitis. Acute appendicitis, inflammatory bowel disease (Crohn's disease or ulcerative colitis), pneumonia, stomach ulcers, gastroesophageal reflux and hiatal hernia, viral hepatitis, kidney stones, urinary tract infections, diverticulosis or diverticulitis, pregnancy complications, and even a heart attack can potentially mimic a gallbladder attack. Some experts recommend that the test be repeated if an ultrasound does not detect stones, but the health care provider still strongly suspects gallstones. Stones or a dilated bile duct may only be detected during ultrasound less than 50% of the time. In an ultrasound variation called endoscopic ultrasound (EUS), the physician places an endoscope (a thin, flexible plastic tube containing a tiny camera) into the patient's mouth and down the esophagus, stomach, and then the first part of the small intestine. Computed tomography (CT) scans may be helpful if the doctor suspects complications, such as perforation, common duct stones, or other problems such as cancer in the pancreas or gallbladder.
Cholescintigraphy, a nuclear imaging technique, is more sensitive than ultrasound for diagnosing acute cholecystitis. Such results are most common in alcoholic patients with liver disease or patients who are fasting or receiving all their nutrition intravenously. Endoscopic retrograde cholangiopancreatography (ERCP) was once the gold standard for detecting common bile duct stones, particularly because stones can be removed during the procedure.
With the technological advancement of noninvasive imaging techniques, ERCP is now generally limited to patients who have severe cholangitis and a high likelihood of common bile ducts stones, which would need to be removed.
Virtual endoscopy is an experimental technique that uses data from CT and MRI scans to generate a three-dimensional view of various body structures. Experts suggest a wait-and-see approach, which they have termed expectant management, for these patients. Gallstones almost never spontaneously disappear, except sometimes when they are formed under special circumstances, such as pregnancy or sudden weight loss. Patients with no fever or serious medical problems who show no signs of severe pain or complications and have normal laboratory tests may be discharged from the hospital with oral antibiotics and pain relievers. Patients may electively choose to have their gallbladder removed (called cholecystectomy) at their convenience. A small number of patients may be candidates for stone-breaking techniques called lithotripsy, using a laser or electric charge. Drug therapy for gallstones is available for some patients who are unwilling to undergo surgery, or who have serious medical problems that increase the risks of surgery.
The first step if there are signs of acute cholecystitis is to "rest" the gallbladder in order to reduce inflammation.
These are administered if the patient shows signs of infection, including fever or an elevated white blood cell count, or in patients without such signs who do not improve after 12 - 24 hours. The most common procedure now is laparoscopy, a less invasive technique than open cholecystectomy (which involves a wide abdominal incision). Patients who have developed gallstone-associated pancreatitis almost always have a cholecystectomy during the initial hospital admission or very soon afterward.
If noninvasive diagnostic tests suggest obstruction from common duct stones, the doctor will perform endoscopic retrograde cholangiopancreatography (ERCP) to confirm the diagnosis and remove stones. The procedure involves the use of an endoscope (a flexible telescope containing a miniature camera and other instruments), which is passed down the throat to the bile duct entrance. This is an approach through the abdomen, but it uses small incisions instead of one large incision.
Many surgeons believe that laparoscopy is becoming safe and effective, and should be the first choice.
Oral medications have lost favor with the increased use of laparoscopy, but they may still have some value in specific circumstances. Another exenatide-related drug is Bydureon® which is a once-a-week injectable form of exenatide.
A more recent addition to the GLP-1 receptor agonist family of diabetes drugs is Trulicity® (dulaglutide) manufactured by Eli Lilly and Co. Additionally, it has been shown that metformin affects mitochondrial activities dependent upon the model system studied. The latter effects of metformin were recognized in epidemiological studies of diabetic patients taking metformin versus those who were taking another anti-hyperglycemia drug. The ladies snacked on a fruit and cheese plate during their three-and-a-half-hour stay, and while Robin and Joyce drank cocktails, Kim sipped on pink lemonade. This thickened fluid consists of a mucus gel containing cholesterol and calcium bilirubinate. They are more likely to develop in people with hemolytic anemia (a relatively rare anemia in which red blood cells are broken down at an abnormally high rate) or cirrhosis (scarred liver). Primary common duct stones are usually of the brown pigment type and are more likely to cause infection than secondary common duct stones.
Such inflammation usually results from reduced blood supply or an inability of the gallbladder to properly contract and empty its bile. Infection develops in about 20% of patients with acute cholecystitis, and increases the danger from this condition. Inflammation can also cause necrosis (destruction of tissue in the gallbladder), which leads to gangrene.
In general, this occurs in people who wait too long to seek help, or in people who do not respond to treatment. The pancreatic duct, which carries digestive enzymes, joins the common bile duct right before it enters the intestine. Symptoms of gallbladder cancer usually do not appear until the disease has reached an advanced stage and may include weight loss, anemia, recurrent vomiting, and a lump in the abdomen. Small gallbladder polyps (up to 10 mm) pose little or no risk, but large ones (greater than 15 mm) pose some risk for cancer, so the gallbladder should be removed.


Porcelain gallbladders have been associated with a very high risk of cancer, although recent evidence suggests that the risk is lower than was previously thought.
Estrogen raises triglycerides, a fatty substance that increases the risk for cholesterol stones. One study of nursing home residents reported that 66% of the women and 51% of the men had gallstones. People of Asian descent who develop gallstones are most likely to have the brown pigment type.
Pima women have an 80% chance of developing gallstones during their lives, and virtually all native Indian females in Chile and Peru develop gallstones.
In such cases, the liver over-produces cholesterol, which is delivered into the bile and causes it to become supersaturated. For this reason, many centers request that patients undergo cholecystectomy before their bariatric procedure.
Some evidence suggests that high levels of triglycerides may impair the emptying actions of the gallbladder. Up to 40% of patients on home intravenous nutrition develop gallstones, and the risk may be higher in patients on total intravenous nutrition. Patients over age 60 and those who have had numerous bowel operations (particularly in the region where the small and large bowel meet) are at especially high risk. The complications can be so severe that some organ transplant centers require the patient's gallbladder be removed before the transplant is performed. In addition, cholesterol-lowering drugs known as fibrates and thiazide diuretics may slightly increase the risk for gallstones. Gallstones are not associated with diets high in non-heme iron foods such as beans, lentils, and enriched grains.
Fish oil may be particularly beneficial in patients with high triglyceride levels, because it improves the emptying actions of the gallbladder.
Diets that are high in carbohydrates (such as pasta and bread) can also increase risk, because carbohydrates are converted to sugar in the body. Even small amounts (1 ounce per day) have been found to reduce the risk of gallstones in women by 20%.
The caffeine in coffee is thought to stimulate gallbladder contractions and lower the cholesterol concentrations in bile. Nevertheless, because gallstones are common and most cause no symptoms, simply finding stones does not necessarily explain a patient's pain, which may be caused by any number of ailments.
A computed tomography (CT) scan, along with a number of laboratory tests, can determine the severity of the condition. It is the diagnostic method most frequently used to detect gallstones and is the method of choice for detecting acute cholecystitis. Nevertheless, normal ultrasound results, along with normal bilirubin and liver enzyme tests are very accurate indications that there are no stones in the common bile duct. The tip of the endoscope contains a small ultrasound transducer, which provides "close-up" ultrasound images of the anatomy in the area. Helical (spiral) CT scanning is an advanced technique that is faster and obtains clearer images.
It is most likely to be useful in a small group of patients who have symptoms that suggest gallbladder or biliary tract problems, but whose ultrasound and other routine tests have been negative. The test has largely been replaced by ultrasound; however, it may be useful in some cases for determining the structural and functional status of the gallbladder, often before nonsurgical procedures. The images resemble those used in endoscopy (an invasive procedure), but the procedure is noninvasive.
At some point, the stones may cause pain, serious complications, or both, and require treatment. Recurrence rates are high with nonsurgical options, and the introduction of laparoscopic cholecystectomy has greatly reduced the use of nonsurgical therapies.
Surgery may be done within hours to weeks after the acute episode, depending on the severity of the condition. For gallstone pancreatitis, immediate surgery may be better than waiting up to 2 weeks after discharge, as current guidelines recommend.
It is used in combination with ultrasound or a cholangiogram (an imaging technique in which a dye is injected into the bile duct and moving x-rays are used to view any stones). Still, laparoscopy for common bile duct stones should only be performed by surgeons who are experienced in this technique.
Metformin has a mild inhibitory effect on complex I of oxidative phosphorylation, has antioxidant properties, and activates both glucose-6-phosphate dehydrogenase, G6PDH and AMP-activated protein kinase, AMPK.
The sunny afternoon wasn't the first time Kim flaunted her baby bump in a bikini during her pregnancy, since we also saw her in a two-piece during her family getaway to Greece back in April. But in some cases a stone may cause the gallbladder to become inflamed, resulting in pain, infection, or other serious complications.
Some experts believe bilirubin may play an important role in the formation of cholesterol gallstones. If they do occur, complications usually develop from stones in the bile duct, or after surgery. The highest risk is in men over 50 who have a history of heart disease and high levels of infection. Sometimes, in these cases, gallstones can actually pass into the small intestine, which can be very serious and requires immediate surgery. It is therefore not unusual for stones that pass through or lodge in the lower portion of the common bile duct to obstruct the pancreatic duct. Patients with polyps 10 - 15 mm have a lower risk, but they should still discuss gallbladder removal with their doctor.
This condition may develop from a chronic inflammatory reaction that may actually be responsible for the cancer risk. Men who have their gallbladder removed are more likely to have severe disease and surgical complications than women. A single gene, however, does not explain the majority of cases, so multiple genes and environmental factors play a complex role. It is suspected that the cause is lack of stimulation in the gut, because patients who also take some food by mouth have less risk of developing gallstones.
However drinking other caffeinated beverages, such as soda and tea, does not seem to have the same benefit.
Orlistat (Xenical), a drug for treating obesity, may protect against gallstone formation during weight loss. The risk for gallstone-associated pancreatitis is highest in older Caucasian and Hispanic women.
If possible, the patient should not eat for 6 or more hours before the test, which takes only about 15 minutes. EUS is useful and quite accurate when the health care provider suspects common bile duct stones, but they are not seen on a regular ultrasound and the patient is not clearly ill. With this process, the patient lies on a table while a donut-like, low-radiation x-ray tube rotates around the patient.
For these patients, performing a MRCP can eliminate the need for ERCP and its side effects.
Some studies suggest the patient's age at diagnosis may be a factor in the possibility of future surgery.
Note: Drug treatments are generally inappropriate for patients who have acute gallbladder inflammation or common bile duct stones, because delaying or avoiding surgery could be life threatening. This technique is used along with antibiotics if infection is present in the common duct (cholangitis). In skilled centers, endoscopic (including transoral) techniques are becoming the gold standard. The importance of AMPK in the actions of metformin stems from the role of AMPK in the regulation of both lipid and carbohydrate metabolism (see AMPK: Master Metabolic Regulator for more details). The reason for the decline in symptoms after 10 years is not known, although some doctors suggest that "younger," smaller stones may be more likely to cause symptoms than larger, older ones. The risk for perforation increases with a condition called emphysematous cholecystitis, in which gas forms in the gallbladder. The condition can be life threatening, particularly if the infection spreads to other parts of the body. Either surgery or a procedure known as endoscopic sphincterotomy is required to open and drain the ducts. Polyps are often detected in this condition and have a very high likelihood of being cancerous. The cancer risk appears to depend on the presence of specific factors, such as partial calcification involving the inner lining of the gallbladder. In general, women are probably at increased risk because estrogen stimulates the liver to remove more cholesterol from blood and divert it into the bile. However, treatment for gallstones in this population is associated with a low risk of complications. It should be noted, however, that even moderate alcohol intake increases the risk for breast cancer in women.
The drug appears to reduce bile acids and other components involved in gallstone production. About 25% of pancreatitis cases are severe, and the rate is much higher in people who are obese. During the procedure, the doctor can check the liver, bile ducts, and pancreas, and quickly scan the gallbladder wall for thickening (characteristic of cholecystitis).
Opioids such as morphine may have fewer adverse effects, but some doctors avoid them in gallbladder disease. In adipose tissue, metformin inhibits lipolysis while enhancing re-esterification of fatty acids.
Acalculous gallbladder disease will often cause symptoms similar to those of gallbladder stones. HRT may also be a less-than-attractive option for women because studies have shown it has negative effects on the heart and increases the risk for breast cancer. Pregnant women, people who are unable to drink in moderation, and those with liver disease should not drink at all. The activation of AMPK by metformin is likely related to the inhibitory effects of the drug on complex I of oxidative phosphorylation. This is a dangerous and misleading event, however, because peritonitis (widespread abdominal infection) develops afterward. This would lead to a reduction in ATP production and, therefore, an increase in the level of AMP and as a result activation of AMPK.
In fact, since the cells of the gut will see the highest doses of metformin they will experience the greatest level of inhibited complex I which may explain the gastrointestinal side effects (nausea, diarrhea, anorexia) of the drug that limit its utility in many patients. However, I now have a secret weapon to conquer my fear of salad. I love red onions, and I love garlic. So the two together created a delicious flavor explosion in my mouth that I just have to share.. Determined to overcome my salad challenged attitude, I began looking at various recipes on the web for chopped salads, and using several as a guide (to which I added my own twist of course) I came up with this great tasting blend of fresh corn, black beans, olives, peppers and avocado.
But rest assured that this delicious looking AND TASTING vegan hamburger recipe will have you happy and feeling great about your cruelty free choice.
Instead, you can join the party with something just as tasty, happy in your stance of cruelty free food choices. And though most vegan cheeses aren’t QUITE the same as cow or goat milk based cheeses, there are many commercial brands and some home made versions which definitely fill the void.
The sender was raving about the fabulousness of this mac and cheese, which I have to admit got my attention. The part I didn’t like was burning my oven for two hours to cook four patties of wheat meat. We were surprised that such a modestly priced mix passed our taste test for vegans and omnis with flying color and a five-star rating.



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Comments

  1. 09.07.2016 at 19:38:35


    Sugar tolerance foods, most sweeteners, grains, cookies, pastries, cakes 6.8%, equal to 4.4.

    Author: Zezag_98
  2. 09.07.2016 at 18:26:59


    Their urine is negative for glucose, it automatically means they.

    Author: Rashid