Medical Questions & Answers

Question: My parents both had gall stones. I am worried that I might too. Who gets gall stones and how are they treated?
Fair, fat, female, forty and flatulent. These are the people who, according to traditional medical textbooks, are more likely to suffer from gall stones. Of course the problem can occur in many people outside this group, but I find it quite surprising just how many do belong to this ‘5F’ group. Problems occur when the bile in the gall bladder becomes too concentrated and precipitates out as a crystal or stone. Small stones can pass out along the ducts, but larger stones block up the bile ducts, and when the gall bladder contracts, the movement of the stone in the duct causes severe pain.
The only effective treatment is surgery to remove the gall bladder and the stones it contains. If there are no acute problems, it can be carried out routinely at the patient’s convenience. Some patients can have stones very low in the common bile duct removed by an instrument that is passed through the mouth and stomach into the intestine. Patients who are too old or ill for an operation may use an expensive drug that slowly dissolves some gall stones over many months.
A newer technique to disintegrate gall stones by ultrasound waves is being trialed in some hospitals, but this is not routinely available yet.

Question: Following an extensive liver resection for metastatic cancer my husband developed intense itching all over but there is no sign of a rash. What could cause this?
The liver is an extraordinarily complex organ that is responsible for the production of many of the body’s essential chemicals and enzymes, and for removing waste products from the blood stream. Any surgery to the liver may interfere with these processes, and metastatic deposits of cancer may also have an effect. If any one of the hundreds of substances produced in the liver is being manufactured in excess, or in insufficient quantities, there may be a minor imbalance in the body’s metabolism. The same applies if one particular waste product is not being removed efficiently. Either problem can lead to a wide variety of symptoms, one of which could easily be an itch.
Identifying the chemical imbalance can be very difficult or impossible, as it may be an interaction between two or more different substances. If nothing obvious is found on routine investigation, it is often just a matter of time while your husband waits for the liver to repair itself (which it usually does).
In the meantime, there are medications that can be prescribed by your general practitioner to ease the itch and discomfort. You should discuss the various options further with him/her.

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