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.
Biliary
colic is the most common symptom of gallstones, but, fortunately, it is usually a self-limiting symptom.
There are, however, more serious complications of gallstones.
Cholecystitis
Cholecystitis means inflammation of the gallbladder.
Like biliary colic, it too is caused by sudden obstruction of the ducts by a gallstone, usually the
cystic duct. In fact, cholecystitis may begin with an episode of biliary colic. Obstruction of the
cystic duct causes the wall of the gallbladder to begin secreting fluid just as with biliary colic,
however, for unclear reasons, inflammation sets in. At first the inflammation is sterile, that is,
there is no infection with bacteria; however, over time the bile and gallbladder become infected with
bacteria that travel through the bile ducts from the intestine.
With cholecystitis, there is constant pain in the right upper abdomen. Inflammation extends through the wall of
the gallbladder, and the right upper abdomen becomes particularly tender when it is pushed or even tapped.
Unlike with biliary colic, however, it is painful to move. Individuals with cholecystitis usually lie
still. There is fever, and the white blood cell count is elevated, both signs of inflammation.
Cholecystitis usually is treated with antibiotics, and most episodes will resolve over several days.
Even without antibiotics, cholecystitis often resolves. As with biliary colic, movement of the
gallstone out of the cystic duct and back into the gallbladder relieves the obstruction and allows
the inflammation to resolve.
Cholangitis
Cholangitis is a condition in which bile in the common, hepatic, and intrahepatic
ducts becomes infected. Like cholecystitis, the infection spreads through the ducts from
the intestine after the ducts become obstructed by a gallstone. Patients with cholangitis are very
sick with high fever and elevated white blood cell counts. Cholangitis may result in an abscess within
the liver or sepsis. (See discussion of sepsis that follows.)
Gangrene
Gangrene of the gallbladder is a condition in which the inflammation of
cholecystitis cuts off the supply of blood to the gallbladder. Without blood, the tissues forming
the wall of the gallbladder die, and this makes the wall very weak. The weakness combined with infection
often leads to rupture of the gallbladder. The infection then may spread throughout the abdomen, though
often the rupture is confined to a small area around the gallbladder (a confined perforation).
Jaundice
Jaundice is a
condition in which bilirubin accumulates in the body. Bilirubin is brownish-black
in color but is yellow when it is not
too concentrated. A build-up of bilirubin in the body turns the skin and whites of the eye (sclera)
yellow. Jaundice occurs when there is prolonged obstruction of the bile ducts. The obstruction may be due
to gallstones, but it also may be due to many other causes, for example, tumors of
the bile ducts or surrounding tissues. (Other causes of jaundice are a rapid destruction of red
blood cells that overwhelms the ability of the liver to remove bilirubin from the blood or a damaged liver that
cannot remove bilirubin from the blood normally.) Jaundice, by itself, generally does not cause problems.
Pancreatitis
Pancreatitis means inflammation
of the pancreas. The two most common causes of pancreatitis are
alcoholism and gallstones.
The pancreas surrounds the common bile duct as it enters the intestine. The pancreatic duct that drains
the digestive juices from the pancreas joins the common bile duct just before it empties into the intestine.
If a gallstone obstructs the common bile duct just after the pancreatic duct joins it, flow of pancreatic juice from the pancreas is blocked. This results in inflammation within the pancreas. Pancreatitis due to gallstones usually is mild, but it may cause serious illness and even death. Fortunately, severe pancreatitis due to gallstones is rare.
Sepsis
Sepsis is a condition in which bacteria from any source within the body, including the gallbladder or bile ducts,
enter into the blood stream and spread throughout the body. Although the bacteria usually remain within the blood, they also may spread to distant tissues and lead to the formation of abscesses (localized areas of infection with formation of pus). Sepsis is a feared complication of any infection. The signs of sepsis include high fever, high white blood cell count, and, less frequently, rigors (shaking chills) or a
drop in blood pressure.
Fistula. A fistula is an abnormal tract through which fluid can flow between two hollow organs or between an abscess and a hollow organ or skin. Gallstones cause fistulas when the hard gallstone erodes through the soft wall of the gallbladder or bile ducts. Most commonly, the gallstone erodes into the small intestine, stomach, or common bile duct. This can leave a tract that allows bile to flow from the gallbladder to the small intestine, stomach, or
the common bile duct. If the fistula enters the distal part of the small intestine, the concentrated bile can lead to problems such as diarrhea. Rarely, the gallstone erodes into the abdominal cavity. The bile then leaks from the gallbladder or bile duct throughout the
abdominal cavity and causes inflammation of the lining of the abdomen (peritoneum), a condition called bile peritonitis.
Ileus. Ileus is a condition
in which there is an obstruction to the flow of food, gas, and liquid within the intestine. It may be due to a mechanical obstruction, for example, a tumor within the intestine, or a functional obstruction, for example, inflammation of the intestine or surrounding tissues that prevents the muscles of the intestine from working normally and propelling its contents. If a large gallstone erodes through the wall of the gallbladder and into the stomach or small intestine, it will be propelled through the small intestine. The narrowest part of the small intestine is the ileo-cecal valve, which is located
at the site where the small intestine joins the colon. If the gallstone is too large to pass through the valve, it can obstruct the small intestine and cause an ileus.
Cancer.Cancer of the gallbladder almost always is associated with gallstones, but it is not clear which comes first, that is, whether the gallstones precede the cancer and, therefore, could potentially be the cause of the cancer. Moreover, cancer of the gallbladder arises in less than 1% of individuals with gallstones. Therefore, concern about future development of cancer alone is not a good reason for removing the gallbladder when gallstones are present.
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.
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