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नोट : यहाँ पर प्रस्तुत आलेखों में स्वास्थ्य सम्बन्धी जानकारी को संकलित करके पाठकों के समक्ष प्रस्तुत करने का छोटा सा प्रयास किया गया है। पाठकों से अनुरोध है कि इनमें बताई गयी दवाओं/तरीकों का प्रयोग करने से पूर्व किसी योग्य चिकित्सक से सलाह लेना उचित होगा।-राजेश मिश्रा

स्वास्थ लाभ के साथी, इस वेबसाइट से जुड़ें : राज

सोमवार, फ़रवरी 02, 2015

Prevention and Treatment of Gallstones

गॉल ब्लाडर में पथरी का घरेलू उपचार

पित्त की थैली में पथरी (गॉल ब्लैडर स्टोन) का होना एक आम स्वास्थ्य समस्या है। पित्त की थैली पेट के दाएं ऊपरी भाग में लिवर के ऊपर चिपकी होती है। इसमें लिवर से बनने वाले एंजाइम संचित होते... हैं। दुनिया में लाखों ऐसे मरीज है जो गुर्दे की पथरी से परेशान है। गॉल ब्लाडर में पथरी बनना एक भयंकर पीड़ादायक रोग है। इसे पित्त पथरी कहते हैं। पित्ताशय में दो तरह की पथरी बनती है। प्रथम कोलेस्ट्रोल निर्मित पथरी। दूसरी पिग्मेन्ट से बननेवाली पथरी। जिसमें से लगभग अस्सी प्रतिशत पथरी कोलेस्ट्रोल तत्व से ही बनती हैं।
वैसे तो यह रोग किसी को भी और किसी भी आयु में हो सकता है लेकिन महिलाओं में इस रोग के होने की सम्भावना पुरुषों की तुलना में कम होती है। पित्त की पथरी को घरेलू उपचार के माध्यम से ठीक किया जा सकता है।
पित्त लिवर में बनता है और इसका भंडारण गॉल ब्लेडर में होता है। यह पित्त वसायुक्त भोजन को पचाने में मदद करता है। जब इस पित्त में कोलेस्ट्रोल और बिलरुबिन की मात्रा ज्यादा हो जाती है, तो पथरी निर्माण के लिये आदर्श स्थिति बन जाती है। यह बीमारी आमतौर पर तीस से साठ वर्ष के उम्र के लोगों में पाई जाती है और स्त्रियों की अपेक्षा पुरूषों में चार गुना अधिक पाई जाती है। बच्चों और वृद्धों में मूत्राशय की पथरी ज्यादा बनती है, जबकि वयस्को में अधिकतर गुर्दो और मूत्रवाहक नली में पथरी बनती है। पथरी के जिन मरीजों को डायबिटीज की बीमारी होती है उनको गुर्दे की बीमारी होने की काफी संभावनाएं रहती हैं। अगर किसी मरीज को रक्तचाप की बीमारी है तो उसे नियमित दवा से रक्त चाप को नियंत्रण करने पर विशेष ध्यान देना चाहिए क्योंकि अगर रक्तचाप बढ़ता है, तो इस बिमारी से भी गुर्दे खराब हो सकते हैं। प्रेग्नेन्सी, मोटापा, मधुमेह, अधिक बैठे रेहने बले लोगों, तेल घी अधिकता वाले भोजन और शरीर में खून की कमी से पित्त पथरी रोग होने की सम्भावना बढ़ जाती है। इस समस्या को कुछ घरेलू उपचारों द्वारा नियंत्रित किया जा सकता है।

पित्त की पथरी के घरेलू उपाय-

  • गाजर और ककडी का रस को सौ मिलिलिटर की मात्रा में मिलाकर दिन में दो बार पीने से पित्त की पथरी में लाभ होता है।
  • सुबह खाली पेट पचास मिली लीटर नींबू का रस पीने से एक सप्ताह में लाभ होता है।
  • शराब, सिगरेट, चाय, कॉफी तथा शकर युक्त पेय हानिकारक हैं। इनसे जितना हो सके बचने की कोशिश करें।
  • नाशपती पित्त की पथरी में फायदेमंद होती है, इसे खूब खायें। इसमें पाये जाने वाले रसायनिक तत्वों से पित्ताषय के रोग दूर होते हैं।
  • विटामिन सी अर्थात एस्कोर्बिक एसिड के प्रयोग से शरीर का प्रतिरक्षा प्रणाली मजबूत बनती है। यह कोलेस्ट्रोल को पित्त में बदल देता है। इसकी तीन से चार गोली रोज लेने पर पथरी में लाभ होता है।
  • पित्त पथरी के रोगी भोजन में अधिक से अधिक मात्रा में हरी सब्जीयां और फल लें। इनमें कोलेस्ट्रोल कम मात्रा में होता है और यह प्रोटीन की जरूरत भी पूरी करते हैं।
  • तली और मसालेदार चीजों से दूर रहें और संतुलित भोजन ही करें।
  • चुकंदर का जूस और गाजर का जूस बराबर मात्रा में मिलाकर पीने से पित्ताषय(गाल ब्लाडर) और किडनी के रोग नष्ट होते हैं।
  • गुर्दे या गॉल ब्लैडर की पथरी निकालने में प्याज का रस काफी प्रभावी होता है। प्याज के रस में चीनी मिलाकर शरबत की तरह पीने से पथरी बाहर निकल जाती है।
अदरक पित्त स्राव को बढ़ा देता है। इसलिए पित्त की पथरी या पित्ताशय की थैली रोग से पी‍ड़‍ित लोगों को अक्सर गॉल ब्‍लैडर के अटैक के जोखिम को कम करने के लिए अदरक से बचने की सलाह दी जाती है। ऐसे रोगी पूरी तरह से अदरक का सेवन समाप्त नहीं करते हैं, लेकिन इस उत्पाद के किसी भी तरह के उपयोग एक चिकित्सक की सलाह के तहत होना चाहिए।



Prevention and Treatment of Gallstones



The following natural protocol helps to correct liver dysfunction, in addition to helping combat gallstones (liver stones). It will holistically improve a person's overall health too. Several of the recommendations target cholesterol, because stones are often made of cholesterol.
Reduce fat intake overall, especially unnatural and toxic fats like hydrogenated oils, soy, and canola. Natural fats (like butter) are better, but they should be used in moderation nonetheless.
Omega-3 supplementation is recommended by way of flax seed oil capsules.
Niacin (Vitamin B3) is helpful for people with cholesterol or skin problems.
Red yeast rice reduces cholesterol, and its active compound is used to make pharmaceutical drugs for cholesterol. This has the benefits of the drugs, without the dangers, addictions, or expense. For years, the F.D.A. tried to block sales of unprocessed red yeast rice and supplemental extracts, because they competed with the patented drugs that are based on the same rice; so the all-natural rice was conveniently reclassified as a 'drug'. This has become a common trick ever since the U.S. Congress forbade the F.D.A. from regulating nutritional supplements, in lieu of similar abusive behaviors.
Sunlight exposure converts the excess cholesterol reserves stored inside skin into vitamin D-2, which is later used by the liver to make vitamin D-3. Therefore, sunlight helps in multiple ways. It dramatically boosts the immune system.
Exercise. No explanation should be required.
Milk thistle (available as a supplement) is a liver tonic.
Dandelion root (available as a supplement) is another liver tonic.
Avoid soy lecithin and all soy products. Soy products can have disastrous effects upon hormone balance, and this is especially true for women. The phytoestrogens inside soy products attack the thyroid. The presence of gallstones has been shown to have a relationship with hormone imbalances. Also, be advised that all soy is now genetically engineered.
Vitamin C makes cholesterol more water soluble, allowing a body to better eliminate excesses.
Turmeric increases the solubility of bile.
Consume apple cider vinegar, lemonade, or apple juice regularly. Supplementing with several tablespoons of apple cider vinegar per day is best.
Castor oil transdermal packs neutralize inflammation. A rag must be soaked in pure, cold pressed castor oil that is obtained from a health food store beforehand. The excess should be squeezed-out just prior to use. Next the rag should be placed on bare skin over the organ. Put a piece of plastic on top of the rag. Then place a hot water bottle on top of that. The hot water bottle should be made as hot as possible, so long as the patient can tolerate it. If the person is numbed by drugs or otherwise, then use some common sense in helping the person to get an appropriate level of heat. This transdermal system should remain in place for a minimum of 30 minutes, and doing this daily will benefit most patients. It is also recommended that the immediate area underneath the patient be covered in plastic too, because some of the castor oil will run down onto furniture or floors.
Licorice is another liver tonic.
The 2-Day Naturopathic Gallbladder Cleanse Procedure
There are other, more thorough cleanses available, but these take a minimum of a week to implement. Anyone trying to rid himself of gallstones wants fast relief.
Ingredients
1/2 cup of cold pressed, extra virgin olive oil
1 large grapefruit (or 2 small)
3 lemons (optional)
4 tablespoons of Epsom salt
3 cups of fresh grapefruit juice or fresh apple juice
Chamomile supplements
Preparation
Test to see if you have a bad reaction to Epsom salt by holding about a 1/4 tsp. of it in your mouth for about half a minute, and then swallow it. If there are any problems, then this entire procedure is a no-go. This test is essential for safety, because an allergic reaction to the massive amounts used later could be fatal.
This is a 2-day procedure, so ensure that you have two days that are completely free of obligations before beginning. Most people should begin on a Saturday.
Try a chamomile tea to test for ragweed and chamomile allergies.
Discontinue all medicines, vitamins, pills, and herbs if possible.
Procedure
Eat a no-fat breakfast and lunch, such as oatmeal (or porridge) with fruit, fruit juice, bread and preserves, bread with honey, baked potato, or vegetables that are salted only. Consume no butter, milk, or cheese. These fat-free meals allow bile to build up and develop increased pressure within the liver.
2:00 P.M. -- Discontinue all food. No cheating! Breaking this rule can later cause illness and a failure of the flush. Prepare the Epsom salt solution by mixing 4 tablespoons with 3 cups (24 fluid ounces) of grapefruit juice or apple juice inside a large jar. This makes four servings of 3/4 a cup. Place the jar inside a refrigerator to get it cold (this is for convenience and improved taste). Grapefruit and apple have properties that aid the cleanse, in addition to making the procedure more bearable.
6:00 P.M. -- Drink one serving (3/4 of a cup) of the Epsom salt solution. You may add 1/8 tsp. of Vitamin C powder to improve the taste. You may also drink a few mouthfuls of water afterward, or rinse your mouth. Place the cold-pressed olive oil and grapefruit on the kitchen counter to warm up.
8:00 P.M. -- Repeat by drinking another 3/4 cup of Epsom salt solution. Ready yourself for resting, because timing is important for success.
At 9:45 P.M. -- Pour 1/2 a cup of olive oil into the pint jar. Wash grapefruit in hot water and dry. Then squeeze out the juice, by hand, into the measuring cup. Remove the excessive pulp. You may add lemon juice to improve the flavor. Add the juice(s) to the olive oil. Seal the jar tightly and shake it vigorously. This should make at least 1/2 a cup (3/4 a cup is better) of this mixture, but do not drink it yet. Visit the bathroom, even if it makes you late for your ten o'clock drink. Do not be more than 15 minutes late, or you will expel fewer stones.
10:00 P.M. -- Drink the olive oil solution. Take four 300 mg. chamomile capsules with the first sips to help you sleep through the night. Drinking through a large plastic straw helps it go down easier. You may use oil and vinegar salad dressing, or straight honey to chase it down between sips. Have these ready in a tablespoon on the kitchen counter. Make certain you drink it standing up. Get it swallowed within 5 minutes (fifteen minutes for very elderly or weak persons). Lie down immediately afterward on your right side. The sooner that you lie down, the more stones you will get out. Be prepared for bed ahead of time. Do not bother with clean up, because timing is very important. Try to keep perfectly still for at least 20 minutes after laying. You may feel a train of stones traveling along the bile ducts like marbles. There should be no pain because the bile ducts are dilated to full size, due to the Epsom salt solution. Go to sleep.
Next Morning -- Upon awakening, take your third dose of the Epsom salt solution. If you have indigestion or nausea at any point, treat it with ginger supplements, and wait until it has passed before drinking the Epsom salt solution. If you absolutely can not hold the ginger in the stomach, then hold the ginger powder in the mouth for direct blood absorption through your cheek tissues. You should return to bed after you have finally consumed the Epsom salt solution. Do not begin this step before 6:00 A.M.
Two hours later -- Take your final dose of the Epsom salt solution and return to bed again.
Two more hours -- You may finally eat again. Begin with only fruit juices. Half an hour later, eat fruit. After another thirty minutes, you may eat regular foods, but keep the meal light. By evening, you should feel recovered.
  • Gallstones are "stones" that form in the gallbladder or bile ducts.
  • The common types of gallstones arecholesterol, black pigment, and brown pigment.
  • Cholesterol gallstones occur more frequently in several ethnic groups and are associated with femalegender,obesity, pregnancy, oral hormonal therapy, rapid loss of weight, elevated blood triglyceride levels, and Crohn's disease.
  • Black pigment gallstones occur when there is increased destruction of red blood cells, while brown pigment gallstones occur when there is reduced flow and infection of bile.
  • The majority of gallstones do not cause symptoms.
  • The most common symptoms of gallstones are biliary colic and cholecystitis. Gallstones do not cause intolerance to fatty foods, belching, abdominal distention, or gas.
  • Complications of gallstones include cholangitis, gangrene of the gallbladder, jaundice, pancreatitis,sepsis, fistula, and ileus.
  • Gallbladder sludge is associated with symptoms and complications of gallstones; however, like gallstones, sludge usually does not cause problems.
  • The best single test for diagnosing gallstones is transabdominal ultrasonography. Other tests include endoscopic ultrasonography, magnetic resonance cholangio-pancreatography (MRCP), cholescintigraphy (HIDA scan), endoscopic retrograde cholangio-pancreatography (ERCP), liver and pancreaticblood tests, duodenal drainage, oral cholecystogram (OCG), and intravenous cholangiogram(IVC).
  • Gallstones are managed primarily with observation (no treatment) or removal of the gallbladder (cholecystectomy). Less commonly used treatments include sphincterotomy and extraction of gallstones, dissolution with oral medications, and extra-corporeal shock-wave lithotripsy (ESWL). Prevention of cholesterol gallstones also is possible with oral medications.
  • Symptoms of gallstones should stop following cholecystectomy. If they do not, it is likely that the gallstones were left in the ducts, there is a second problem within the bile ducts, orthere is sphincter of Oddi dysfunction.
  • Continuing research is directed at uncovering the genes that are responsible for the formation of gallstones.



What are gallstones?

Gallstones (often misspelled as gall stones, or gall stone) are stones that form in the gall (bile) within the gallbladder. (The gallbladder is a pear-shaped organ just below the liver that stores bile secreted by the liver.)
Bile is a watery liquid made by the cells of the liver that is important for digesting food in the intestine, particularly fat.
Liver cells secrete the bile into small canals within the liver.
The bile flows through the canals and into larger collecting ducts within the liver (the intrahepatic bile ducts).
The bile then flows through the intrahepatic bile ducts out of the liver and into the extrahepatic bile ducts-first into the hepatic bile ducts, then into the common hepatic duct, and finally into the common bile duct.
From the common bile duct, there are two different directions that bile can flow.
The first direction is through the common bile duct and directly into the intestine where the bile mixes with food and promotes digestion of food.
The second direction is into and offshoot of the common bile duct, the cystic duct, and from there into the gallbladder (often misspelled as gall bladder).


What are the symptoms of gallstones?


The majority of people with gallstones have no signs or symptoms and are unaware of their gallstones. (The gallstones are "silent.") The gallstones often are found as a result of tests (for example, ultrasound or X-ray examination of the abdomen) performed while evaluating medical conditions other than gallstones. Symptoms can appear later in life, however, after many years without symptoms. Thus, over a period of five years, approximately 10% of people with silent gallstones will develop symptoms. Once symptoms develop, they are likely to continue and often will worsen.

Gallstones are blamed for many symptoms they do not cause. Among the symptoms gallstones do not cause are:
dyspepsia (including abdominal bloating and discomfort after eating),
intolerance to fatty foods,
belching, and
flatulence (passing gas or farting).

When signs and symptoms of gallstones occur, they virtually always occur because the gallstones obstruct the bile ducts.

The most common symptom of gallstones is biliary colic. Biliary colic is a very specific type of pain, occurring as the primary or only symptom in 80% of people with gallstones who develop symptoms. Biliary colic occurs when the bile ducts (cystic, hepatic ducts or common bile duct) are suddenly blocked by a gallstone. Slowly-progressing obstruction, as from a tumor, does not cause biliary colic. Behind the obstruction, fluid accumulates and distends the ducts and gallbladder. In the case of hepatic duct or common bile duct obstruction, this is due to continued secretion of bile by the liver. In the case of cystic duct obstruction, the wall of the gallbladder secretes fluid into the gallbladder. It is the distention of the ducts or gallbladder that causes biliary colic.

Characteristically, biliary colic comes on suddenly or builds rapidly to a peak over a few minutes.
It is a constant pain, it does not come and go, though it may vary in intensity while it is present.
It lasts for 15 minutes to 4-5 hours. If the pain lasts more than 4-5 hours, it means that a complication - usually cholecystitis - has developed.
The pain usually is severe, but movement does not make the pain worse. In fact, patients experiencing biliary colic often walk about or writhe (twist the body in different positions) in bed trying to find a comfortable position.
Biliary colic often is accompanied by nausea.
Most commonly, biliary colic is felt in the middle of the upper abdomen just below the sternum.
The second most common location for pain is the right upper abdomen just below the margin of the ribs.
Occasionally, the pain also may be felt in the back at the lower tip of the scapula on the right side.
On rare occasions, the pain may be felt beneath the sternum and is mistaken for angina or a heart attack.
An episode of biliary colic subsides gradually once the gallstone shifts within the duct so that it is no longer causing obstruction.


How are gallstones treated?



Most gallstones are silent.
If silent gallstones are discovered in an individual at age 65 (or older), the chance of developing symptoms from the gallstones is only 20% (or less) assuming a life span of 75 years. In this instance, it is reasonable not to treat the individual.
In younger individuals, no treatment also may be appropriate if the individuals have serious, life-threatening diseases, for example, seriousheart disease, that are likely to shorten their life span.
On the other hand, in healthy young individuals, treatment should be considered even for silent gallstones because the individuals' chances of developing symptoms from the gallstones over a lifetime will be higher. Once symptoms begin, treatment should be recommended since further symptoms are likely and more serious complications can be prevented.
Cholecystectomy


Cholecystectomy (removal of the gallbladder surgically) is the standard treatment for gallstones in the gallbladder. Surgery may be done through a large abdominal incision, laparoscopically or robotically through small punctures in the abdominal wall. Laparoscopic surgery results in less pain and a faster recovery. Robot-assisted laparoscopic surgery has 3D visualization. Cholecystectomy has a low rate of complications, but serious complications such as damage to the bile ducts and leakage of bile occasionally occur. There also is risk associated with the general anesthesia that is necessary for either type of surgery. Problems following removal of the gallbladder are few. Digestion of food is not affected, and no change in diet is necessary. Chronicdiarrhea occurs in approximately 10% of patients.
Sphincterotomy and extraction of gallstones


Sometimes a gallstone may be stuck in the hepatic or common bile ducts. In such situations, there usually are gallstones in the gallbladder as well, and cholecystectomy is necessary. It may be possible to remove the gallstone stuck in the duct at the time of surgery, but this may not always be possible. An alternative means for removing gallstones in the duct before or after cholecystectomy is with sphincterotomy followed by extraction of the gallstone.

Sphincterotomy involves cutting the muscle of the common bile duct (sphincter) at the junction of the common bile duct and the duodenum in order to allow easier access to the common bile duct. The cutting is done with an electrosurgical instrument passed through the same type of endoscope that is used for ERCP. After the sphincter is cut, instruments may be passed through the endoscope and into the hepatic and common bile ducts to grab and pull out the gallstone or to crush the gallstone. It also is possible to pass a lithotripsy instrument that uses high frequency sound waves to break up the gallstone. Complications of sphincterotomy and extraction of gallstones include risks associated with general anesthesia, perforation of the bile ducts or duodenum, bleeding, and pancreatitis.
Oral dissolution therapy


It is possible to dissolve some cholesterol gallstones with medication taken orally. The medication is a naturally-occurring bile acid called ursodeoxycholic acid or ursodiol (Actigall, Urso). Bile acids are one of the detergents that the liver secretes into bile to dissolve cholesterol. Although one might expect therapy with ursodiol to work by increasing the amount of bile acids in bile and thereby cause the cholesterol in gallstones to dissolve, the mechanism of ursodiol's action actually is different. Ursodiol reduces the amount of cholesterol secreted in bile. The bile then has less cholesterol and becomes capable of dissolving the cholesterol in the gallstones.

There are important limitations to the use of ursodiol:
It is only effective for cholesterol gallstones and not pigment gallstones.
It works only for small gallstones, less than 1-1.5 cm in diameter.
It takes one to two years for the gallstones to dissolve, and many of the gallstones reform following cessation of treatment.

Due to these limitations, ursodiol generally is used only in individuals with smaller gallstones that are likely to have a very high cholesterol content and who are at high risk for surgery because of ill health. It also is reasonable to use ursodiol in individuals whose gallstones were perhaps formed because of a transient event, for example, rapid loss of weight, since the gallstones would not be expected to recur following successful dissolution.
Extracorporeal shock-wave lithotripsy


Extracorporeal shock-wave lithotripsy (ESWL) is an infrequently used method for treating gallstones, particularly those lodged in bile ducts. ESWL generators produces shock waves outside of the body that are then focused on the gallstone. The shock waves shatter the gallstone, and the resulting pieces of the gallstone either drain into the intestine on their own or are extracted endoscopically. Shock waves also can be used to break up gallstones via special catheters passed through an endoscope at the time of ERCP.


Can gallstones be prevented?


Ideally, it would be better if gallstones could be prevented rather than treated. Prevention of cholesterol gallstones is feasible since ursodiol, the bile acid medication that dissolves some cholesterol gallstones, also prevents them from forming. The difficulty is to identify individuals who are at a high risk for developing cholesterol gallstones over a relatively short period of time so that the duration of preventive treatment can be limited. One such group is obese individuals losing weight rapidly with very low calorie diets or with surgery. The risk of gallstones in this group is as high as 40% to 60%. In fact, ursodiol has been shown in several studies to be very effective at preventing gallstones in these individuals.
Can symptoms continue after gallstones are removed?


Removal of the gallbladder (cholecystectomy) should eliminate all gallstone-related symptoms except in three situations:
gallstones were left in the ducts,
there were problems with the bile ducts in addition to gallstones, and
gallstones were not the cause of the symptoms.

The possibility of gallstones in the ducts can be pursued with MRCP, endoscopic ultrasound, and ERCP. Rarely, gallstone-like symptoms can be caused by a condition called sphincter of Oddi dysfunction, discussed below.

The common bile duct has a muscular wall. The last several centimeters of the common bile duct's muscle immediately before the duct joins the duodenum comprise the sphincter of Oddi. The sphincter of Oddi controls the flow of bile. Since the pancreatic duct usually joins the common bile duct shortly before it enters the duodenum, the sphincter also controls the flow of fluid from the pancreatic duct. When the muscle of the sphincter tightens, it shuts off the flow of bile and pancreatic fluid. When it relaxes, bile and pancreatic fluid flow into the duodenum, for example, after a meal. The sphincter may become scarred, and the duct is narrowed by the scarring. (The cause of the scarring is unknown.) The sphincter also may go into spasm intermittently. In either case, the flow of bile and pancreatic fluid may intermittently stop abruptly, mimicking the effects of a gallstone causing biliary colic and pancreatitis.

The diagnosis of sphincter of Oddi dysfunction can be difficult to make. The best diagnostic test requires an endoscopic procedure with the same type of endoscope as ERCP. Instead of filling the ducts with dye, however, the pressure within the sphincter is measured. If the pressure is abnormally high, scarring or spasm of the sphincter are likely. The treatment for sphincter of Oddi dysfunction is sphincterotomy. (described previously). The measurement of liver and pancreatic enzymes in the blood also may be useful in diagnosing sphincter dysfunction.

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