Pathogenesis and treatment of gallstones

Article Abstract:

Gallstones are found in about 10% of all adults and are a major cause of illness and death. In patients of Western nations, they are composed primarily of cholesterol, along with bilirubin, calcium salts, and proteins. They form when the cholesterol concentration in bile is greater than the bile's capacity to keep it in solution. Cholesterol crystals form and over time become stones. They are more prevalent in women than in men and are associated with childbearing, estrogen therapy, use of oral contraceptives, obesity and rapid weight loss. Pain in the upper right quadrant of the abdomen is the most common complaint, although many patients with gallstones have no symptoms. Treatment is generally recommended only for symptomatic patients and patients with acute cholecystitis or bile-duct obstruction. Until the 1980s, open surgical cholecystectomy was the standard treatment, but since then laparoscopic techniques, which are less painful and costly, have become the preferred method of treatment.

Care and treatment, Gallstones

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Evaluation of abnormal liver-enzyme results in asymptomatic patients

Article Abstract:

Whenever a patient has elevated liver enzymes but no symptoms, the doctor should repeat the blood test to make sure it is correct. Elevated blood levels of liver enzymes is usually caused by liver damage. However, a minimal elevation is probably not important if the patient is known not to have liver disease. Elevated liver enzymes can be caused by alcohol, some drugs, chronic hepatitis, autoimmune hepatitis, hemochromatosis, Wilson's disease, hepatic steatosis, and alpha(sub 1)-antitrypsin deficiency. Celiac sprue, muscle disorders, and strenuous exercise can also cause elevated liver enzymes.

Measurement, Physiological aspects, Liver diseases, Enzymes

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Iron-chelation therapy with oral deferiprone - toxicity or lack of efficacy?

Article Abstract:

More research is needed to determine if the drug deferiprone is safe and effective in treating iron overload. People with beta-thalassemia need regular blood transfusions, but this increases the level of iron in their body. The only approved treatment is deferoxamine, but it has serious side effects, is expensive and must be given intravenously. Deferiprone can be taken orally but a 1998 study found that it was not effective in lowering iron levels and may cause liver damage. However, the study had some flaws which could invalidate this conclusion.

Editorial, Evaluation, Chelating agents

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