American Medical Association Family Medical Guide - American Medical Association [522]
Symptoms
When excess copper attacks the liver, a person can develop symptoms of hepatitis (see page 786), including jaundice (yellowing of the skin and whites of the eyes; see page 785), abdominal swelling and pain, and vomiting blood. Excess copper in the brain produces tremors in the arms and hands, rigid muscles, and speech and language problems. Women who have Wilson’s disease may have irregular menstrual periods or no periods, infertility, or multiple miscarriages.
Diagnosis
A diagnosis of Wilson’s disease can be made relatively easily even in people who don’t have symptoms. The doctor will feel your abdomen for signs of swelling of the liver or spleen or fluid buildup in the lining of the abdomen. He or she will also order tests to measure the level of copper in your blood, urine, and liver. An eye examination may be done to look for a rusty-brown ring around the cornea (called the Kayser-Fleischer ring) that is characteristic of Wilson’s disease. The earlier the diagnosis is made, the less damage to the liver and brain and the better the outcome.
Treatment
Wilson’s disease is treated with zinc (which blocks the absorption of copper) or penicillamine or trientine (which help remove copper from tissues). You will need to take the medication throughout your life. You will also need to avoid eating copper-rich foods such as mushrooms, nuts, chocolate, dried fruit, liver, and shellfish. Ask your doctor if you should take a zinc supplement to help prevent your intestines from absorbing copper.
Gallstones
Stones of varying composition sometimes form in the gallbladder, the reservoir in which the digestive substance bile collects. Bile flows from the liver to the gallbladder, which excretes bile into the intestines to help neutralize stomach acid and aid in the digestion of fat. Bile is rich in cholesterol (a fat that is manufactured and excreted by the liver) and bilirubin (a substance formed from the breakdown of old red blood cells). Sometimes, if the balance of the cholesterol and bilirubin in the bile is upset, a tiny solid particle can form in the gallbladder. The particle may grow to become a gallstone as more cholesterol or, less often, bilirubin builds up around it. Some people may have only one gallstone, while others have several.
An estimated 20 million people in the United States have gallstones, with 1 million new cases diagnosed each year. Autopsy studies have shown that 80 percent of all people who reach 90 years of age have gallstones when they die.
Common sites of gallstones
Gallstones may remain in the gallbladder or pass easily through the bile duct into the upper part of the small intestine (the duodenum) without causing symptoms. However, problems can develop if a gallstone gets trapped in the cystic duct or in a bile duct.
Symptoms
Between one third and one half of people with gallstones do not have any symptoms. However, some gallstones flow out of the liver in bile and get stuck in the common bile duct. A stone in the bile duct causes severe pain in the right side or in the center of the upper abdomen, which can radiate around the ribs or through to the back; this pain is called biliary colic. Biliary colic results when the gallbladder and the muscle of the bile duct clamp down and try to empty the stone into the intestines. If the stone falls back into the gallbladder, or is forced along the bile duct into the intestines, the blockage goes away and the pain quickly subsides. For this reason, the pain tends to build to a peak over a period of a few hours and then fade. A person usually has nausea and vomiting. If you have severe pain on your right side or in your upper abdomen, call your doctor immediately or go to the nearest hospital emergency department.
Biliary colic
A gallstone can sometimes get stuck in the common bile duct, causing pain in the right side or in the center of the upper abdomen. If the stone