Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Gallstones are common; they occur in approximately 20% of women in the US, Canada and Europe, but there
is a large variation in prevalence among ethnic groups. For example, gallstones occur 1 ½ to 2 times more
commonly in Scandinavians and Mexican-Americans. Among American Indians, gallstone prevalence reaches
more than 80%. These differences probably are accounted for by genetic (hereditary) factors. First-degree
relatives (parents, siblings, and children) of individuals with gallstones are 1 ½ times more
likely to have gallstones than if they did not have a first-degree relative with gallstones. Further support comes from twin studies that
show that genetic factors are important in determining who develops gallstones.
Among non-identical pair of twins (who share 50% of their genes with each other), both individuals in a
pair have gallstones 8% of the time. Among identical pair of twins (who share 100% of their genes with
each other), both individuals in a pair have gallstones 23% of the time.
There are several types of gallstones and each type has a different cause.
Cholesterol gallstones
Cholesterol gallstones are primarily of
made up of
cholesterol. They
are the most common type of gallstone, comprising 80% of gallstones in individuals
in Europe and the Americas.
Cholesterol is one of the substances that liver cells secrete into bile. (Secretion
of cholesterol into bile is an important mechanism by which the liver eliminates excess cholesterol from
the body.)
In order for bile to carry cholesterol, the cholesterol must be dissolved in the bile.
Cholesterol is a fat, however, and bile is an aqueous or watery solution; fats do not dissolve in
watery solutions. In order to make the cholesterol dissolve in bile, the liver also secretes two
detergent-bile acids and lecithin-into the bile. These detergents, just like dish-washing detergents,
dissolve the fatty cholesterol so that it can be carried by bile through the ducts. If the liver
secretes too much cholesterol for the amount of bile acids and lecithin it secretes, some of the
cholesterol does not dissolve. Similarly, if the liver does not secrete enough bile acids and lecithin,
some of the cholesterol also does not dissolve. In either case, the undissolved cholesterol sticks
together and forms particles of cholesterol that grow in size and eventually form gallstones.
There are two other processes that promote the formation
of cholesterol gallstones though neither process is able to form cholesterol
gallstones by itself. The first is an abnormally rapid formation and growth of
cholesterol particles into gallstones. Thus, with the same concentrations of cholesterol, bile acids and lecithin in their bile,
patients with gallstones form particles of cholesterol more rapidly than individuals without gallstones. The second process
that promotes the formation and growth of gallstones is reduced contraction and emptying of the
gallbladder that allows bile to stay in the gallbladder longer than normal so that there is more time for cholesterol
particles to form and grow.
Pigment gallstones
Pigment gallstones are the second most common type of gallstone.
Although pigment gallstones comprise only 15% of gallstones in individuals from Europe and the Americas,
they are more common than cholesterol gallstones in Southeast Asia. There are two types of pigment
gallstones 1) black pigment gallstones, and 2) brown pigment gallstones.
Pigment is a waste product
formed from hemoglobin, the oxygen-carrying chemical in
red blood cells. The hemoglobin from old red blood cells that are being destroyed is changed into a chemical
called bilirubin and released into the blood. Bilirubin is removed from the blood by the liver. The
liver modifies the bilirubin and secretes the modified bilirubin into bile.
Black pigment gallstones: If there is too much bilirubin in bile, the
bilirubin combines with other constituents in bile, for example, calcium, to form pigment (so-called because it is
dark brown in color). Pigment dissolves poorly in bile and, like cholesterol, it sticks together
and forms particles that grow in size and eventually form gallstones. The pigment gallstones that form in
this manner are called black pigment gallstones because they are black and hard.
Brown pigment gallstones: If
there is reduced contraction of the gallbladder or obstruction to the flow of bile through the ducts, bacteria
may ascend from the duodenum into the bile ducts and gallbladder. The bacteria alter the bilirubin in the
ducts and gallbladder, and the altered bilirubin then combines with calcium to form pigment.
The pigment then combines with fats in bile (cholesterol and fatty acids from lecithin) to form particles that
grow into gallstones. This type of gallstone is called a brown pigment gallstone because it is more
brown than black. It also is softer than black pigment gallstones.
Other types of gallstones. Other types of gallstones are rare. Perhaps the most interesting type is the
gallstone that forms in patients taking the antibiotic, ceftriaxone (Rocephin). Ceftriaxone is unusual in that
it is eliminated from the body in bile in high concentrations. It combines with calcium in bile
and becomes insoluble. Like cholesterol and pigment, the insoluble ceftriaxone and calcium form particles
that grow into gallstones. Fortunately, most of these gallstones disappear once the antibiotic is
discontinued; however, they still may cause problems until they disappear. Another rare type of
gallstone is formed from calcium carbonate.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Crohn's disease is a chronic inflammatory disease,
primarily involving the small and large intestine, but which can
affect other parts of the digestive system as well. Abdominal pain, diarrhea, vomiting, fever, and weight loss are
common symptoms.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Liver disease can be cause by a variety of things including infection (hepatitis), diseases such as gallstones, high cholesterol or triglycerides, blood flow obstruction to the liver, and toxins (medications and chemicals). Symptoms of liver disease depends upon the cause; however, common symptoms may include nausea, vomiting, upper right abdominal pain, and jaundice. Treatment depends upon the cause of the liver disease.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Pancreatitis is a rare disease in which the pancreas becomes inflamed, occurring when digestive enzymes are activated and begin attacking the pancreas causing damage to the gland. There are two types of pancreatitis, acute and chronic. Most commonly caused by alcohol or gallstones, it can lead to bleeding in the gland, serious tissue damage, infection, and cysts. Enzymes and toxins may then enter the bloodstream and seriously injure organs, such as the heart, lungs, and kidney.
Jaundice is a yellowish staining of the skin and whites of the eyes (sclerae) with bilirubin, the pigment found in bile. Jaundice can be an indicator of liver or gallbladder disease, or it may result from the rupture of red blood cells (hemolysis).
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Stool color is generally brown. When stool color changes, often, an individual becomes concerned. The presence of the bilirubin in bile is generally responsible for stool color. Bilirubin concentration can vary bile color from light yellow to almost black in color. Changes in bilirubin can cause stool to turn green, gray, or clay-like in color. Intestinal bleeding may turn stool black, tarry, red, maroon, or smelly stool. Medication and food may also affect stool color.
Dyspepsia (indigestion) is a functional disease in which the gastrointestinal organs, primarily the stomach and first part of the small intestine, function abnormally. It is a chronic disease in which the symptoms fluctuate infrequency and intensity. Symptoms of dyspepsia include upper abdominal pain, belching, nausea, vomiting, abdominal bloating, early satiety, and abdominal distention (swelling). These symptoms are most often provoked by eating.
Pleurisy, an inflammation of the lining around the lungs, is associated with sharp chest pain upon breathing in. Cough, chest tenderness, and shortness of breath are other symptoms associated with pleurisy. Pleurisy pain can be managed with pain medication and by external splinting of the chest wall.
Cystic fibrosis is a disease of the mucus and sweat glands. Cystic fibrosis is an inherited disease. The outcome of the disease leaves the body malnourished, bulky and fouls smelling stools, vitamin insufficiency, gas, painful or swollen abdomen, infertility, susceptible to heat emergencies, and respiratory failure. There is no cure for cystic fibrosis, treatment of symptoms is used to manage the disease.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
Sickle cell anemia (sickle cell disease), a blood disease which shortens life expectancy, is cause by an inherited abnormal hemoglobin. Symptoms may include bacterial infections, painful swelling of the hands and feet, fever, leg ulcers, fatigue, anemia, eye damage, and lung and heart injury. Treatment for sickle cell anemia aims to manage and prevent the worst manifestations of the disease and focuses on therapies that block red blood cells from stacking together, which can lead to tissue and organ damage and pain.
The liver is the largest solid organ in the body, and is actually an gland. The liver has a wide variety of critical functions such as manufacturing proteins and metabolizing fats and carbohydrates. The liver also eliminates harmful biochemical waste products from the body (alcohol, drugs, toxins). The liver secretes bile that aids in digestion. Examples of diseases of the liver include cirrhosis, hepatitis, cancer, and fatty liver. Symptoms of liver disease include bleeding, easy bruising, edema, fatigue, and jaundice.
Pancreatic cysts are collections of fluid within the pancreas. Some are benign, malignant, or pseudocysts. There are two major types of pancreatic cysts, inflammatory cysts and non-inflammatory cysts. Non-inflammatory cysts include: serous cyst adenomas, mucinous cyst adenomas, intraductal papillary mucinous neoplasm (IPMN), and solid pseudopapillary tumor of the pancreas. Symptoms of pancreatic cysts include abdominal pain, jaundice, fever, chills, and sepsis. Treatment depends on the type of cyst, and patient health.
Nausea and vomiting are symptoms that may be caused by many conditions. Antiemetics are drugs that treat nausea and vomiting. Though some antiemetics for motion sickness and mild nausea are available over the counter (OTC), most require a medical evaluation and prescription.
Beta Thalassemia is the most familiar type of thalassemia. Thalassemia is not just one disease but rather a complex series of genetic (inherited) disorders all of which involve underproduction of hemoglobin.
Gallbladder cancer is a rare form of cancer with symptoms that include jaundice, abdominal pain, fever, nausea and vomiting, abdominal lumps, and bloating. Risk factors include being female and Native American. Treatment of gallbladder cancer depends upon the stage of the cancer, the type of gallbladder cancer, and whether the cancer can be removed by surgery.
Alpha thalassemia is a disorder in which the alpha globin protein is underproduced. There are two pairs of genes that carry the code for the alpha chains of hemoglobin. When one gene is impaired, that person is in a carrier state and suffers no medical problems. When four genes are impaired, the production of fetal and adult hemoglobin is prevented, resulting in hydrops fetalis and leading to death before birth.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Asbestos exposure lung disease is divided into three main types, asbestosis (lung scarring caused by asbestos fibers), disease of the lining of the lung (pleural plaques, scarring, or fluid accumulation), and lung cancer. Mesothelioma is cancer of the lining of the lung caused by asbestos exposure. Cancers of the larynx, throat, kidney, esophagus, and gallbladder have been linked to asbestos exposure. Treatment is dependant upon the type of condition related to asbestos exposure.
Duodenal diverticula (extramural or intramural), or duodenal diverticulum, is a pouch that is attached to the first part of the small intestine (duodenum). The cause of extramural diverticula is not clear, however, it may be congenital. Complications caused by duodenal diverticulum include rupture, gallstones, or pancreatitis. Extramural duodenal diverticula has no symptoms. Treatment is generally surgery.
Choledochal cysts are cysts of the bile ducts. There are several different types of choledochal cysts. These cysts are congenital, however, their cause is not known. Symptoms of choledochal cysts in infants include an enlarged liver and jaundice. In older people, the cysts cause abdominal pain, jaundice, cholangitis, gallstones, and pancreatitis. Treatment for choledochal cysts is surgery.
Fast food consumption and lack of exercise are just a couple of causes of childhood obesity. Health effects of childhood obesity include type 2 diabetes, heart attack, stroke, high cholesterol, asthma, sleep apnea, gallstones, fatty liver disease, GERD, depression, and eating disorders.
Digestion RSS
Healthy Living Tips
This site complies with the