is inflammation of the appendix, a small portion of the large intestine that
hangs down from the lower right side. Although the appendix does not seem to
serve any purpose, it can still become diseased. If untreated, an inflamed
appendix can burst, causing infection and even death. About 1 in 500 people have
appendicitis each year.
may occur after a viral infection in the digestive tract or when the tube
connecting the large intestine and appendix is blocked by trapped stool. The
inflammation can cause infection, a blood clot, or rupture of the appendix.
Because of the risk of rupture, appendicitis is considered an emergency. Anyone
with symptoms needs to see a doctor immediately. Symptoms include
Pain in the
right side of the abdomen. The pain usually begins near the navel and moves down
and to the right. The pain becomes worse when moving, taking deep breaths,
coughing, sneezing, and being touched in the area.
that begins after other symptoms
· Abdominal swelling
if you have some of these symptoms, see a doctor. Not everyone has all symptoms.
It is important that people with symptoms of appendicitis not take laxatives or
enemas to relieve constipation because these medicines could cause the
appendix to burst. People also should not take pain medicine because it can mask
symptoms that the doctor needs to know about.
Treatment is surgery to remove the appendix, called appendectomy.
What Are Gallstones?
form when liquid stored in the gallbladder hardens into pieces of stone-like
material. The liquid, called bile is used to help the body digest fats. Bile is
made in the liver, then stored in the gallbladder until the body needs to digest
fat. At that time, the gallbladder contracts and pushes the bile into a
tube-called a duct-that carries it to the small intestine, where it helps with
contains water, cholesterol, fats, bile salts, and bilirubin. Bile salts
break up fat, and bilirubin gives bile and stool a brownish color. If the liquid
bile contains too much cholesterol, bile salts, or bilirubin, it can harden into
two types of gallstones are cholesterol stones and pigment stones. Cholesterol
stones are usually yellow-green and are made primarily of hardened cholesterol.
They account for about 80 percent of gallstones. Pigment stones are small, dark
stones made of bilirubin. Gallstones can be as small as a grain of sand or as
large as a golf ball. The gallbladder can develop just one large stone, hundreds
of tiny stones, or almost any combination.
gallbladder and the ducts that carry bile and other digestive enzymes from
the liver, gallbladder, and pancreas to the small intestine are called
can block the normal flow of bile if they lodge in any of the ducts that carry
bile from the liver to the small intestine. That includes the hepatic ducts,
which carry bile out of the liver; the cystic duct, which takes bile to and from
the gallbladder; and the common bile duct, which takes bile from the cystic and
hepatic ducts to the small intestine. Bile trapped in these ducts can cause
inflammation in the gallbladder, the ducts, or, rarely, the liver. Other ducts
open into the common bile duct, including the pancreatic duct, which carries
digestive enzymes out of the pancreas. If a gallstone blocks the opening to that
duct, digestive enzymes can become trapped in the pancreas and cause an
extremely painful inflammation called pancreatitis.
any of these ducts remain blocked for a significant period of time,
severe-possibly fatal-damage can occur, affecting the gallbladder, liver, or
pancreas. Warning signs of a serious problem are fever, jaundice, and persistent
What Causes Gallstones?
Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason.
The cause of pigment stones is uncertain. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anemia.
It is believed that the mere presence of gallstones may cause more gallstones to develop. However, other factors that contribute to gallstones have been identified, especially for cholesterol stones.
Obesity is a major risk factor for gallstones, especially in women. A large
clinical study showed that being even moderately overweight increases one's risk
for developing gallstones. The most likely reason is that obesity tends to
reduce the amount of bile salts in bile, resulting in more cholesterol. Obesity
also decreases gallbladder emptying.
Excess estrogen from pregnancy, hormone replacement therapy, or birth control
pills appears to increase cholesterol levels in bile and decrease gallbladder
movement, both of which can lead to gallstones.
Native Americans have a genetic predisposition to secrete high levels of
cholesterol in bile. In fact, they have the highest rates of gallstones in the
United States. A majority of Native American men have gallstones by age 60.
Among the Pima Indians of Arizona, 70 percent of women have gallstones by age
30. Mexican-American men and women of all ages also have high rates of
Women between 20 and 60 years of age are twice as likely to develop gallstones
People over age 60 are more likely to develop gallstones than younger people.
Cholesterol-lowering drugs. Drugs that lower cholesterol levels in blood
actually increase the amount of cholesterol secreted in bile. This in turn can
increase the risk of gallstones.
People with diabetes generally have high levels of fatty acids called
triglycerides. These fatty acids increase the risk of gallstones.
Rapid weight loss.
As the body metabolizes fat during rapid weight loss, it causes the liver to
secrete extra cholesterol into bile, which can cause gallstones.
decreases gallbladder movement, causing the bile to become over concentrated with
cholesterol, which can lead to gallstones.
Who Is at Risk for
men and women
fast or lose a lot of weight quickly
women, women on hormone therapy, and women who use birth control pills
What are the Symptoms?
of gallstones are often called a gallstone "attack" because they occur
suddenly. A typical attack can cause
severe pain in the upper abdomen that increases rapidly and lasts from 30
minutes to several hours.
Pain in the
back between the shoulder blades
the right shoulder
· Nausea or vomiting
attacks often follow fatty meals, and they may occur during the night. Other
gallstone symptoms include
intolerance of fatty foods
who also have the following symptoms should see a doctor right away:
color of the skin or whites of the eyes
people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called "silent stones." They do not
interfere in gallbladder, liver, or pancreas function and do not need treatment.
How Are Gallstones
gallstones, especially silent stones, are discovered by accident during tests
for other problems. But when gallstones are suspected to be the cause of
symptoms, the doctor is likely to do an ultrasound exam. Ultrasound uses sound
waves to create images of organs. Sound waves are sent toward the gallbladder
through a handheld device that a technician glides over the abdomen. The sound
waves bounce off the gallbladder, liver, and other organs, and their echoes make
electrical impulses that create a picture of the organ on a video monitor. If
stones are present, the sound waves will bounce off them, too, showing their
What Is Diarrhea?
watery stools occurring more than three times in one day--is a common problem
that usually lasts a day or two and goes away on its own without any special
treatment. However, prolonged diarrhea can be a sign of other problems.
can cause dehydration, which means the body lacks enough fluid (liquid) to
function properly. Dehydration is particularly dangerous in children and the
elderly, and it must be treated promptly to avoid serious health problems.
Dehydration is discussed below.
of all ages can get diarrhea. The average adult has a bout of diarrhea about
four times a year.
What Causes Diarrhea?
may be caused by a temporary problem, like an infection, or a chronic problem,
like an intestinal disease. A few of the more common causes of diarrhea are
infections. Several types of bacteria, consumed through contaminated food or
water, can cause diarrhea.
Some people are unable to digest a component of food, such as lactose,
the sugar found in milk.
Parasites can enter the body through food or water and settle in the digestive
medicines, such as antibiotics, blood pressure medications, and antacids
diseases, like inflammatory bowel disease or celiac disease.
bowel disorders, such as irritable bowel syndrome, in which the intestines do
not work normally.
What Are the Symptoms?
may be accompanied by cramping abdominal pain, bloating, nausea, or an
urgent need to use the bathroom. Depending on the cause, a person may have a
fever or bloody stools.
can be either acute or chronic. The acute form, which lasts less than 3 weeks,
is usually related to a bacterial, viral, or parasitic infection. Chronic
diarrhea lasts more than 3 weeks and is usually related to functional disorders
like irritable bowel syndrome or diseases like celiac disease or inflammatory