1. What are gallstones?
2. What are the symptoms of gallstones?
3. What is a hiatal hernia?
4. What are the surgical treatments for a hiatal hernia?
5. What increases the risk of getting breast cancer?

Question: What are gallstones?

Answer: Gallstones look like small stones or gravel, but are not as hard, and may be up to 3 centimeters across. They are made of cholesterol (a fat) but can include calcium salts (similar to chalk) and solids from red blood cells. They grow in the liver and gallbladder and may take months and years to form. The gall bladder is tucked away under the liver just below the right rib cage and collects bile from the liver. Bile is important in fat digestion and mixes with the food in the intestines. After a meal the gallbladder empties the bile down a tube called the bile duct, into the intestines where it mixes with food for digestion.

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Question: What are the symptoms of gallstones?

Answer: People with gallstones do not know they have them until they block the pipes draining the gallbladder, causing inflammation, or move out of the gallbladder and block the pipe leading directly to the intestine, causing jaundice, fever or severe colic. People with gallstones may have indigestion, perhaps noticed after a rich or heavy meal.

The symptoms of gallbladder trouble are pains below the right ribs and sometimes an ache in the back near the shoulder blade. The symptoms that doctors take most seriously are signs of inflammation in the gallbladder causing pain and fever (acute cholecystitis) or turning yellow (jaundice), a sign of obstruction of the liver. Inflammation may feel like flu but often with pain below the ribs. The urine may turn dark and the motions go very pale, and the whites of the eyes may look yellow. Sometimes the skin turns a dusky yellow rather like a suntan.

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Question: What is a hiatal hernia?

Answer: The diaphragm is a flat muscle that separates the chest cavity from the abdominal cavity. Hiatal hernia develops as an abnormal opening in the diaphragm. The most common type of hiatal hernia occurs in the oesophageal opening in the diaphragm where the oesophagus passes into the stomach. This opening sometimes enlarged, allowing the stomach, omentum and sometimes even other abdominal organs to slide up into the chest.

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Question: What are the surgical treatments for a hiatal herniar?

Answer: The hernia can be repaired by either conventional or laparoscopic methods. Repair of hiatal hernia is a common operation that general surgeons perform. Laparoscopic Herniorrhaphy is being done at a time when Laparoscopic Cholecystectomy has shown definite benefits over the open technique. Over the last few years, laparoscopic hiatal hernia repair has become a widely accepted surgical treatment. This technique allows the surgeon to pull the sac of the hernia down out of the chest and repair the hole in the diaphragm. The mesh repair of the hiatus hernia is also very effective by laparoscopic method. After the repair of the hernias defect fundoplication can be performed laparoscopically if needed. In this operation the fundus of the stomach which is on the left of the esophagus and main portion of the stomach is wrapped around the back of the esophagus until it is once again in front of this structure. The portion of the fundus that is now on the right side of the esophagus is sutured to the portion on the left side to keep the wrap in place. The fundoplication resembles a buttoned shirt collar. The collar is the fundus wrap and the neck represents the esophagus imbricated into the wrap. This has the effect of creating a security valve in the esophagus not to allow the stomach to go up into the chest.

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Question: What increases the risk of getting breast cancer?

Answer: There are a number of risk factors which increase the chances of getting breast cancer. The hormonal influences which have been shown to increase the chance of getting breast cancer are: starting periods early, before the age of 11; entering the menopause late, above the age of 50; not having children, or having your first child over the age of 30.

Conversely, there are some hormonal influences which actually reduce the risk of breast cancer.These include: starting periods later, over the age of 14; having an early menopause; having children, especially if your first pregnancy is before the age of 20; breastfeeding.

The influence of things like diet and environmental factors is less certain, although there is some evidence that obesity, a high fat diet and high alcohol consumption may all be slight risk factors. One other influence is age – the longer a woman lives the more likely it is that a breast cancer will develop.

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