Bladder stones -a galling experience

by Nilma DOLE

An operation in progress to remove stones in the gall bladder

If you're forty, flabby, female and fertile, then you might be at a risk of having gall bladder stones.

"One of the most common ailments in Sri Lanka is stones in the gall bladder," said Dr. Karunasena Nanayakkara of the Kalubowila Teaching Hospital.

Apparently, 10 percent of the population has gall bladder stones and it is increasingly common in Sri Lanka with many surgeries being done nearly every day. "Since many people have medical check-ups now, it is possible to identify if you have gall bladder stones as opposed to before when people didn't know they had it," said Dr. Rohana Siriwardena who also works at the Kalubowila Hospital. He commented, "Nowadays, people can check for gall bladder stones with an X-ray or an ultra-sound scan.

However, in an X-ray, it isn't easy to detect how many stones a patient has but an ultra sound is better". According to the doctor, a patient can be referred to have an MRI (magnetic resonance imaging) or a CT (computed axial tomography) scan to determine the extent of gall bladder stones.

There is no scientific evidence to prove how gallstones occur but it could be a multitude of factors like weight, gallbladder motility (movement), and possibly diet. Certain factors like cholesterol and diabetes could accompany gallstones but it varies between individuals.

"Some patients might not have symptoms at the beginning but if they don't check it, there can be deadly consequences" said Dr. Nanayakkara.

About 90 percent of gallstones cause no symptoms. There is a minor chance of developing pain during the first 10 years after gallstones form. After 10 years, the chance for developing symptoms declines.

On average, symptoms take about eight years to develop. The reason for the decline in symptoms after 10 years is not known, although some doctors suggest that smaller stones may be more likely to cause symptoms than larger, older ones. Acalculous gallbladder disease will often cause symptoms similar to those of gallbladder stones.

The gallbladder is a small sac-like organ in the upper right part of the abdomen. It is located under the liver, just below the front rib cage on the right side. Gallstones (choleliths) are formed when crystalline bodies made of calcium, cholesterol or pigmentation stones arise in the gall bladder. The formation of gallstones can block the bile duct which is instrumental in taking bile (that breaks down fatty food) to the small intestine. "The gall bladder is a sac that stores bile temporarily but it is not a vital element in the digestive system. Those who have removed the gall bladder can live a normal life but their bile duct is bigger", said Dr. Nanayakkara.

Dr. Siriwardena said, "If gallstones are not removed or treated, if the stones obstruct the pancreas, then it would have a serious impact." Obstruction of the common bile duct is choledocholithiasis and the obstruction of the pancreatic exocrine system can cause pancreatitis. "Cholelithiasis is the presence of stones in the gallbladder or bile ducts" said Dr.Nanayakkara.

Speaking about the symptoms of the condition, Dr. Siriwardena said, "Initially, a patient experiences extreme pain in the abdomen which is called biliary colic. This pain can also spread to the back or a patient may complain of a pain under their shoulder blades." Such symptoms may happen after a fatty meal and can continue if the patient doesn't check it.

"Other symptoms include vomiting, abdominal puffiness or bloating, inability to digest fatty foods, belching and indigestion" he said.

Further he commented, "If there is a yellowing of the skin or eyes, then the patient has jaundice and he should consult a doctor immediately".

Dramatic symptoms also include dark urine, lighter stools, rapid heartbeat and abrupt blood pressure drop.

With regard to treatment, Dr. Nanayakkara said that there have been many magical cures offered by Ayurvedha experts for jaundice because they think it is gastritis.

"This isn't true because gall bladder stones can cause jaundice. The best thing would be to do an ultra-sound scan to see what the exact problem is because if you don't diagnose the illness properly, the patient can die" said Dr. Nanayakkara.

The Consultant Gastrointestinal Surgeon said, "In large operations if we firmly believe that a patient has the risk of developing gallstones, then we remove it surgically because it can grow over time. For example, a patient having a single large stone can grow bigger or a patient having multiple stones can cause problems." However, the doctors will not do surgery if they don't deem the patient fit for it.

Dr. Rohana Siriwardena said, "There is oral ursodeoxycholic acid treatment to dissolve cholesterol stones but the medication is costly and the patient can develop gallstones if they don't take treatment regularly." There is scientific research done on lithotripsy (Extracorporeal Shock Wave Lithotripsy) which is a method of concentrating ultrasonic shock waves onto the stones to break them into tiny pieces which are passed out of the body but this will take time to be adopted.

Dr. Karunasena Nanayakkara said, "Since we aren't sure how people can get gallstones, it is always advisable to have a balanced diet, avoiding fatty food and regular exercise to maintain a good BMI."

In making sure your gall bladder is safe, go for regular checkups and do an ultra sound scan in addition to an X-ray. If you have cholesterol or diabetes, make sure you keep it under control and also make sure you don't eat much fatty foods because it can lead to gallstones.

It is difficult to determine if the gall bladder has to be removed just to be on the safe side since some patients ask for appendix removals when doing large surgeries. However, Dr. Nanayakkara said, "Whether we like it or not, we are born with vital parts that make us human. Science and nature have showed that even though we might have ducts or sacs which serve no purpose maybe for bypass surgeries or major necessities, we will need them one day." So make sure you have your whole body intact because you never know when you will need your unimportant parts one day!

Some facts about Gallstones

1. Gallstones occur when bile forms solid particles (stones) in the gallbladder.

2. The stones form when the amount of cholesterol or bilirubin in the bile is high.

3. Other substances in the bile may promote the formation of stones.

4. Pigment stones form most often in people with liver disease or blood disease, who have high levels of bilirubin.

5. Poor muscle tone may keep the gallbladder from emptying completely.

The presence of residual bile may promote the formation of gallstones.

6. Risk factors for the formation of cholesterol gallstones include female gender, being overweight, losing a lot of weight quickly on a "crash" or starvation diet, or taking certain medications such as birth control pills or cholesterol-lowering drugs.

7. Gallstones are the most common cause of gallbladder disease.

8. As the stones mix with liquid bile, they can block the outflow of bile from the gallbladder. They can also block the outflow of digestive enzymes from the pancreas.

9. If the blockage persists, these organs can become inflamed.

Inflammation of the gallbladder is called cholecystitis. Inflammation of the pancreas is called pancreatitis.

10. Contraction of the blocked gallbladder causes increased pressure, swelling, and, at times, infection of the gallbladder.

-Courtesy www.emedicinehealth.com

The evil of childhood obesity

by Dr. W.W.S.W.C. Fernando,

The child's rapid growth takes place in three stages, the first two years, adolescence and puberty. Obesity starts from the foetal growth where you get larger babies than average >3kg. From six months onwards we are giving supplementary and complementary feeding.

If we adhere to wrong feeding habits there will be excess calories in the body resulting in obesity. If the child inherits familial obesity you should be more conscious about his food habits. It is always better to consult a doctor and nutritionist or dietician.

Working women leave the feeding to a second person which may perhaps deny the opportunity for the child to get a balanced diet. So the child will end up in obesity. When measuring the child's obesity, we take the body weight and height, the body markers and indices according to the child's growth of height and weight. WHO has formulated growth standards by taking standard samples from all five continents including India and Sri Lanka. According to those standards we measure the Sri Lankan children sometimes ranking them overweight or obese. Many studies have been done on childhood obesity.

A national level survey has revealed that childhood obesity is more prevalent in the Western Province than other districts in Sri Lanka. The obesity is found to be associated with childhood diabetes, hypercholesterolemia etc., the survey pointed out.

Change of child food pattern to keep pace with the changing life style and the increasing physical activity are the major targets of the Management.

Industrialisation, working mother, increased family income, fast foods are the main causes of childhood obesity.

The findings of the Anemia Survey-Sri Lanka by MRI revealed an overweight and obesity percentage of five in Sri Lanka.

There is no other data on childhood obesity in Sri Lanka. A study done by Prof. Wickramanayake observed that childhood obesity is about 10% in western province (Colombo schools).

Also there are lots of commercial preparations which result in harmful effects. ex. Fat fast which contains herbal preparations reduces water component of the body at the risk of death. When treating childhood obesity it is always advisable to contact a nutrition specialist or a physician.

The writer is a Medical Food and Nutrition Scientist and Specialist.

Cholesterol jumps with menopause, study shows

by Anne HARDING

(Health.com) - Doctors have known for years that a woman's risk of developing heart disease rises after menopause, but they weren't exactly sure why. It wasn't clear whether the increased risk is due to the hormonal changes associated with menopause, to aging itself, or to some combination of the two.

Now, we have at least part of the answer: A new study shows beyond a doubt that menopause, not the natural aging process, is responsible for a sharp increase in cholesterol levels.

This seems to be true of all women, regardless of ethnicity, according to the study, which will be published in next week's Journal of the American College of Cardiology.

"As they approach menopause, many, many women show a very striking increase in cholesterol levels, which in turn increases risk for later heart disease," says the lead author of the study, Karen A. Matthews, Ph.D., a professor of psychiatry and epidemiology at the University of Pittsburgh.

Over a 10-year period, Matthews and her colleagues followed 1,054 U.S.women as they went through menopause. Each year the researchers tested study participants for cholesterol, blood pressure, and other heart disease risk factors such as blood glucose and insulin.

As they approach menopause, many, many women show a very striking increase in cholesterol levels, which in turn increases risk for later heart disease.

In nearly every woman, the study found, cholesterol levels jumped around the time of menopause. (Menopause usually occurs around age 50 but can happen naturally as early as 40 and as late as 60.)

In the two-year window surrounding their final menstrual period, the women's average LDL, or bad cholesterol, rose by about 10.5 points, or about 9 percent. The average total cholesterol level also increased substantially, by about 6.5 percent.

Health.com: The causes of high cholesterol

Other risk factors, such as insulin and systolic blood pressure (the top number in a blood pressure reading), also rose during the study, but they did so at a steady rate, suggesting that the increases- unlike those for cholesterol- were related to aging, not menopause.

Of all the risk factors measured in the study, the changes in cholesterol were the most dramatic.

The jumps in cholesterol reported in the study could definitely have an impact on a woman's health, says Dr. Vera Bittner, a professor of medicine at the University of Alabama at Birmingham, who wrote an editorial accompanying Matthews's study.

"The changes don't look large, but given that the typical woman lives several decades after menopause, any adverse change becomes cumulative over time," says Bittner. "If somebody had cholesterol levels at the lower ranges of normal, the small change may not make a difference.

But if somebody's risk factors were already borderline in several categories, this increase may tip them over the edge and put them in a risk category where treatment may be beneficial."

In a first, the study did not find any measurable differences in the impact of menopause on cholesterol across ethnic groups.

Experts have been unsure how ethnicity may affect the link between menopause and cardiovascular risk, because most research to date has been conducted in Caucasian women. Matthews and her colleagues were able to explore the role of ethnicity because their research is part of the larger Study of Women's Health Across the Nation (SWAN), which includes substantial numbers of African-American, Hispanic, and Asian-American women. More research on the connection between menopause and heart disease risk is needed, according to Matthews. The current study doesn't explain how the increases in cholesterol will affect the rate of heart attacks and mortality down the road, for instance.

As the SWAN study continues, Matthews says, she and her colleagues hope to identify warning signs that will show which women are most at risk for heart disease.

"The important thing is, ultimately, when we can figure out the characteristics of women who have early signs of cardiovascular risk that, if we don't do anything about them, could later result in a heart attack." Women should be aware of the changes in risk factors that occur around menopause, says Bittner, and they should talk to their doctors about whether they need to have their cholesterol checked more often or whether they should begin a cholesterol-lowering treatment, such as a statin.

Maintaining a healthy weight, not smoking, and getting plenty of exercise are essential to help keep cholesterol levels in check, Bittner adds, and she points out that menopause can be an especially difficult time for women to get enough physical activity.

"It often falls by the wayside because women in this age range take care of kids, spouse, aging parents, and often work in addition," she says.

"Midlife is a great time to make these changes," Matthews says. "If we can essentially reset the course to a more health-promoting direction in midlife, then that will have benefits for many years to come."

Wolf Ulian, Ph.D., the founder and executive director of the North American Menopause Society, a nonprofit organization that provides information on menopause to consumers and health-care professionals, says the findings underscore that menopause is a good time for women to adopt healthier lifestyles.

"Menopause is a milestone," he says. "It's a time to take stock and take control and try to enhance the quality of your second half of life." - CNN