GallstonesGallstones duct and causes a blockage, the resulting signs

GallstonesGallstones are hardened deposits of digestive fluid that can form in your gallbladder. Your gallbladder is a small, pear-shaped organ on the right side of your abdomen, just beneath your liver. The gallbladder holds a digestive fluid called bile that’s released into your small intestine.Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.People who experience symptoms from their gallstones usually require gallbladder removal surgery. Gallstones that don’t cause any signs and symptoms typically don’t need treatment.SymptomsGallstones may cause no signs or symptoms. If a gallstone lodges in a duct and causes a blockage, the resulting signs and symptoms may include:l Sudden and rapidly intensifying pain in the upper right portion of your abdomenl Sudden and rapidly intensifying pain in the center of your abdomen, just below your breastbonel Back pain between your shoulder bladesl Pain in your right shoulderl Nausea or vomitingGallstone pain may last several minutes to a few hours.When to see a doctorMake an appointment with your doctor if you have any signs or symptoms that worry you.Seek immediate care if you develop signs and symptoms of a serious gallstone complication, such as:l Abdominal pain so intense that you can’t sit still or find a comfortable positionl Yellowing of your skin and the whites of your eyesl High fever with chillsCausesIt’s not clear what causes gallstones to form. Doctors think gallstones may result when:l Your bile contains too much cholesterol. Normally, your bile contains enough chemicals to dissolve the cholesterol excreted by your liver. But if your liver excretes more cholesterol than your bile can dissolve, the excess cholesterol may form into crystals and eventually into stones.l Your bile contains too much bilirubin. Bilirubin is a chemical that’s produced when your body breaks down red blood cells. Certain conditions cause your liver to make too much bilirubin, including liver cirrhosis, biliary tract infections and certain blood disorders. The excess bilirubin contributes to gallstone formation.l Your gallbladder doesn’t empty correctly. If your gallbladder doesn’t empty completely or often enough, bile may become very concentrated, contributing to the formation of gallstones.Types of gallstonesTypes of gallstones that can form in the gallbladder include:l Cholesterol gallstones. The most common type of gallstone, called a cholesterol gallstone, often appears yellow in color. These gallstones are composed mainly of undissolved cholesterol, but may contain other components.l Pigment gallstones. These dark brown or black stones form when your bile contains too much bilirubin.Risk factorsFactors that may increase your risk of gallstones include:l Being femalel Being age 40 or olderl Being overweight or obesel Being sedentaryl Being pregnantl Eating a high-fat dietl Eating a high-cholesterol dietl Eating a low-fiber dietl Having a family history of gallstonesl Having diabetesl Losing weight very quicklyl Taking medications that contain estrogen, such as oral contraceptives or hormone therapy drugsl Having liver diseaseComplicationsComplications of gallstones may include:l Inflammation of the gallbladder. A gallstone that becomes lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain and fever.l Blockage of the common bile duct. Gallstones can block the tubes (ducts) through which bile flows from your gallbladder or liver to your small intestine. Jaundice and bile duct infection can result.l Blockage of the pancreatic duct. The pancreatic duct is a tube that runs from the pancreas to the common bile duct. Pancreatic juices, which aid in digestion, flow through the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.l Gallbladder cancer. People with a history of gallstones have an increased risk of gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of cancer is elevated, the likelihood of gallbladder cancer is still very small.Tests and procedures used to diagnose gallstones include:l Tests to create pictures of your gallbladder. Your doctor may recommend an abdominal ultrasound and a computerized tomography (CT) scan to create pictures of your gallbladder. These images can be analyzed to look for signs of gallstones.l Tests to check your bile ducts for gallstones. A test that uses a special dye to highlight your bile ducts on images may help your doctor determine whether a gallstone is causing a blockage. Tests may include a hepatobiliary iminodiacetic acid (HIDA) scan, magnetic resonance imaging (MRI) or endoscopic retrograde cholangiopancreatography (ERCP). Gallstones discovered using ERCP can be removed during the procedure.l Blood tests to look for complications. Blood tests may reveal an infection, jaundice, pancreatitis or other complications caused by gallstones.TreatmentLaparoscopic cholecystectomyMost people with gallstones that don’t cause symptoms will never need treatment. Your doctor will determine if treatment for gallstones is indicated based on your symptoms and the results of diagnostic testing.Your doctor may recommend you be alert for symptoms of gallstone complications, such as intensifying pain in your upper right abdomen. If gallstone signs and symptoms occur in the future, you can have treatment.Treatment options for gallstones include:l Surgery to remove the gallbladder (cholecystectomy). Your doctor may recommend surgery to remove your gallbladder, since gallstones frequently recur. Once your gallbladder is removed, bile flows directly from your liver into your small intestine, rather than being stored in your gallbladder. You don’t need your gallbladder to live, and gallbladder removal doesn’t affect your ability to digest food, but it can cause diarrhea, which is usually temporary.l Medications to dissolve gallstones. Medications you take by mouth may help dissolve gallstones. But it may take months or years of treatment to dissolve your gallstones in this way and gallstones will likely form again if treatment is stopped. Sometimes medications don’t work. Medications for gallstones aren’t commonly used and are reserved for people who can’t undergo surgery.PreventionYou can reduce your risk of gallstones if you:l Don’t skip meals. Try to stick to your usual mealtimes each day. Skipping meals or fasting can increase the risk of gallstones.l Lose weight slowly. If you need to lose weight, go slow. Rapid weight loss can increase the risk of gallstones. Aim to lose 1 or 2 pounds (about 0.5 to 1 kilogram) a week.Maintain a healthy weight. Obesity and being overweight increase the risk of gallstones. Work to achieve a healthy weight by reducing the number of calories you eat and increasing the amount of physical activity you get. Once you achieve a healthy weight, work to maintain that weight by continuing your healthy diet and continuing to excercise. Appendicitis   Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen. The appendix doesn’t seem to have a specific purpose.Appendicitis causes pain in your lower right abdomen. However, in most people, pain begins around the navel and then moves. As inflammation worsens, appendicitis pain typically increases and eventually becomes severe.Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix.Signs and symptoms of appendicitis may include:l Sudden pain that begins on the right side of the lower abdomenl Sudden pain that begins around your navel and often shifts to your lower right abdomenl Pain that worsens if you cough, walk or make other jarring movementsl Nausea and vomitingl Loss of appetitel Low-grade fever that may worsen as the illness progressesl Constipation or diarrheal Abdominal bloatingThe site of your pain may vary, depending on your age and the position of your appendix. When you’re pregnant, the pain may seem to come from your upper abdomen because your appendix is higher during pregnancy.Appendicitis can cause serious complications, such as:l A ruptured appendix. A rupture spreads infection throughout your abdomen (peritonitis). Possibly life-threatening, this condition requires immediate surgery to remove the appendix and clean your abdominal cavity.l A pocket of pus that forms in the abdomen. If your appendix bursts, you may develop a pocket of infection (abscess). In most cases, a surgeon drains the abscess by placing a tube through your abdominal wall into the abscess. The tube is left in place for two weeks, and you’re given antibiotics to clear the infection.Once the infection is clear, you’ll have surgery to remove the appendix. In some cases, the abscess is drained, and the appendix is removed immediately.Appendicitis treatment usually involves surgery to remove the inflamed appendix. Before surgery you may be given a dose of antibiotics to prevent infection.Surgery to remove the appendix (appendectomy)Appendectomy can be performed as open surgery using one abdominal incision about 2 to 4 inches (5 to 10 centimeters) long (laparotomy). Alternatively the surgery can be done through a few small abdominal incisions (laparoscopic surgery). During a laparoscopic appendectomy, the surgeon inserts special surgical tools and a video camera into your abdomen to remove your appendix.In general, laparoscopic surgery allows you to recover faster and heal with less pain and scarring. It may be better for people who are elderly or obese. However laparoscopic surgery isn’t appropriate for everyone. If your appendix has ruptured and infection has spread beyond the appendix or you have an abscess, you may need an open appendectomy, which allows your surgeon to clean the abdominal cavity.Expect to spend one or two days in the hospital after your appendectomy.Draining an abscess before appendix surgeryIf your appendix has burst and an abscess has formed around it, the abscess may be drained by placing a tube through your skin into the abscess. Appendectomy can be performed several weeks later after controlling the infection.Expect a few weeks of recovery from an appendectomy, or longer if your appendix burst. To help your body heal:l Avoid strenuous activity at first. If your appendectomy was done laparoscopically, limit your activity for three to five days. If you had an open appendectomy, limit your activity for 10 to 14 days. Always ask your doctor about limitations on your activity and when you can resume normal activities following surgery.l Support your abdomen when you cough. Place a pillow over your abdomen and apply pressure before you cough, laugh or move to help reduce pain.l Call your doctor if your pain medications aren’t helping. Being in pain puts extra stress on your body and slows the healing process. If you’re still in pain despite your pain medications, call your doctor.l Get up and move when you’re ready. Start slowly and increase your activity as you feel up to it. Start with short walks.l Sleep when tired. As your body heals, you may find you feel sleepier than usual. Take it easy and rest when you need to.l Discuss returning to work or school with your doctor. You can return to work when you feel up to it. Children may be able to return to school less than a week after surgery. They should wait two to four weeks to resume strenuous ac