CHOKING
C
choking
Partial or complete inability to breathe
due to an obstruction of the airways.
Choking is often caused by food or
drink entering the
trachea
(the w ind-
pipe) or the bronchi (the main airways
to the lungs) instead of passing from
the
pharynx
(throat) into the
oesophagus
(gullet). Normally, coughing dislodges
the food or drink. An obstruction that
partially blocks the airway, and w hich
cannot be dislodged by coughing, is
more serious. If the airway is complete-
ly blocked, total suffocation w ill occur
if the obstruction is not removed.
If an obstruction cannot be cleared
by the use of first-aid techniques, such
as the
Heimlich manoeuvre
,
or removed
by hand, it may be necessary to per-
form an emergency
tracheostomy
(the
making of an incision into the trachea
and insertion of a tube through it into
the lungs) to restore the airway. The
object may then be removed by
laryngo-
scopy
or
bronchoscopy
(procedures that
involve a viewing tube through w hich
instruments are passed).
cholangiocarcinoma
A cancerous growth in one of the
bile
ducts
.
Cholangiocarcinoma causes
jaun-
dice
and weight loss.
cholangiography
An imaging procedure involving the
use of a
contrast medium
(a substance
that is opaque to
X-rays
) to make the
bile ducts
visible on X-rays. It is used to
diagnose biliary stones (w hich are sim -
ilar to
gallstones
,
but they develop in
the
bile
ducts
instead
of the
gall-
bladder) and narrowing or tumours of
the bile ducts. The procedure is being
superseded by
ultrasound scanning
and
MRI
,
both of w hich can be used to
locate stones.
cholangitis
Inflammation of any of the bile ducts,
such as the common bile duct, w hich
leads from the liver and gallbladder to
the small intestine (see
biliary system
).
There are two forms of the condition:
acute ascending cholangitis and scle-
rosing cholangitis.
ACUTE ASCENDING CHOLANGITIS
This form of cholangitis is usually due
to bacterial infection of the duct and its
bile. The infection, in turn, generally
results from blockage of the duct - for
example, by a gallstone (see
bile duct
obstruction
) .
The infection spreads up
the duct and may affect the liver. The
main symptoms
of acute
ascending
cholangitis are recurrent bouts of
jaun-
dice,
abdominal pain, chills, and fever.
M ild attacks are treated w ith
antibiotic
drugs
and fluids. Severe attacks may be
accompanied by life-threatening
septi-
caemia
(blood poisoning) and
kidney
failure
.
In
these
cases,
the
infected
material may be drained from the bile
duct during surgery or
endoscopy
(a
procedure in w hich instruments are
passed through a viewing tube).
SCLEROSING CHOLANGITIS
In this rare condition, all the bile ducts
w ithin and outside the liver become
narrowed. This causes
cholestasis
(stag-
nation of the bile in the liver), chronic
jaundice, and itchiness of the skin, and
the liver is progressively damaged.
The drug
colestyramine
may relieve
itching. The only other treatment avail-
able is a
liver transplant
.
chole-
A prefix that means “relating to the
bile
or the
biliary system
” ,
as in cholecystitis
(inflammation of the gallbladder).
cholecalciferol
An alternative name for
colecalciferol
,
also called vitamin D3 (see
vitamin
D
).
cholecystectomy
Surgical
removal
of the
gallbladder
.
Cholecystectomy is usually performed
to deal with the presence of trouble-
some
gallstones
.
It is also used in cases
of acute
cholecystitis
(inflammation of
the gallbladder) and as an emergency
treatment for rupture of the gallbladder
or
empyema
(accumulation of pus).
Cholecystectomy may be carried out
using conventional surgery or, more
commonly, by
minimally invasive surgery
using a
laparoscope
(a type of viewing
tube through w hich instruments can
be passed), as shown in the illustrated
box opposite.
cholecystitis
Acute or chronic painful inflammation
of the
gallbladder
.
CAUSES AND SYMPTOMS
Acute cholecystitis is usually caused by
a
gallstone
obstructing the outlet from
the gallbladder. The trapped bile inside
becomes more concentrated, because
water is absorbed from it, and irritates
the gallbladder walls. Bacterial infec-
tion of the bile may result. The main
symptom
of
acute
cholecystitis
is
severe, constant pain in the right side of
the abdomen under the ribs, accompa-
nied by fever and, occasionally,
jaundice
.
Repeated m ild attacks of acute chole-
cystitis can lead to a chronic form of
the condition, in w hich the gallbladder
shrinks, its walls thicken, and it ceases
to store bile. Symptoms include indi-
gestion, pains in the upper abdomen,
nausea,
and belching;
they may be
aggravated by eating fatty foods.
TREATMENT AND COMPLICATIONS
Treatment of cholecystitis usually invol-
ves the use of
analgesic drugs
,
antibiotic
drugs
,
and an intravenous infusion of
nutrients and fluids. In some affected
people,
complications
develop. These
may include
peritonitis
(inflammation of
the lining of the abdominal cavity), if
the gallbladder bursts, and
empyema
(an
accumulation of pus). Both of these
complications require urgent surgical
treatment.
Cholecystectomy
(removal of
the gallbladder) is the usual treatment
for chronic cholecystitis.
cholecystography
An X-ray procedure in w hich a
contrast
medium
(a substance that is opaque
to X-rays) is used for viewing of the
gallbladder
and common
bile duct
.
The
technique of cholecystography is usu-
ally used for the detection of
gallstones
but has largely been replaced by
ultra-
sound scanning
of the gallbladder.
cholecystokinin
A
hormone
that is produced in the
duo-
denum
(the first section of the small
intestine) in response to the ingestion
of fats and certain other food sub-
stances. Cholecystokinin stimulates the
gallbladder
to release bile into the duo-
denum, and triggers the secretion of
digestive enzymes from the
pancreas
,
thus aiding the breakdown of foods to
release
nutrients.
Cholecystokinin
is
also found in the brain, where it has a
function as a
neurotransmitter
.
choledochal cyst
A widening of the common bile duct,
w hich carries the digestive juice bile
from the liver and gallbladder to the
duodenum
.
The disorder is congenital
(present at birth), but symptoms may
not develop until early adulthood; they
consist of abdominal pain and jaundice
(yellow coloration of the skin and eyes
due to the accumulation of bilirubin, a
bile pigment). Surgery is needed to
correct the abnormality.
168
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