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Monday, 2 December 2013

Gallstone - The Causes and Risk Factors

A gallstone formed within the gallbladder as a result of changes in bile acid (BA) metabolism and gallbladder function are critical factors in the pathogenesis of gallstones. Gallstones can cause blockage the flow of bile through the bile ducts that can lead to inflammatory causes of  acute cholecystitis. Gallstones are most common among older adults, women, overweight people, etc.

B. Causes and Risk factors
B.1. Causes
 High cholesterol or bilirubin in the bile 
Gallstones are precipitations of oversaturated bile fluid. They can develop in the gallbladder and in the efferent bile ducts; they are very often correlated with diseases of the gallbladder, bile ducts and neighboring organs(5).

B.2. Risk factors
1. hypertriglyceridemia, overweight and insulin resistant
 Patients with hypertriglyceridemia (HTG) - often overweight and insulin resistant - are at risk for gallstone disease(6).

2. Pregnancy and gender
Pregnant women(6b)  and Elder are at higher risk to develop (specially, pigment stones in elder) gallstones(6a)

3. Haemoglobin E beta thalassaemia
in the study to  determine whether this has a genetic basis we compared the bilirubin levels and frequency of gallstones in patients with different alleles of the UGT*1 gene, showed that the UGT*1 genotpe is of importance in the genesis of gallstones in this population of patients(7).

4. Obesity and weight loss
In the study to investigate the relation of obesity and weight loss to the formation of gallstones according to pertinent clinical and research issues, showed that during weight loss, particularly among the obese, an increased risk exists for symptomatic gallstone formation. This acute risk offers the opportunity to investigate the cause of gallstones and possibly to prevent them(8).

5. Diet
Diet with high in saturated fat  and low in fiber increase the risk of gallstones as a result of  increased cholesterol in the bile.

6. Ethnicity
Certain races may be at the increased of the development of gallstone such as American Indians, Mexican  have a genetic predisposition to secrete high levels of cholesterol in bile.

7. Hormone replacement therapy in postmenopausal women and oral contraceptives have also been described to be associated with an increased risk for gallstone disease(8a).

 
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Sources
(5) http://www.ncbi.nlm.nih.gov/pubmed/423995
(6) http://www.ncbi.nlm.nih.gov/pubmed/20699090
(6a) http://www.ncbi.nlm.nih.gov/pubmed/7771432
(6b) http://www.ncbi.nlm.nih.gov/pubmed/17103289
(7) http://www.ncbi.nlm.nih.gov/pubmed/11425418
(8) http://www.ncbi.nlm.nih.gov/pubmed/8214980
(8a) http://www.ncbi.nlm.nih.gov/pubmed/17103289