Christine P.

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Gall Bladder Stone

Sample of a Gall Bladder Stone

Description:
Gall bladder /Gall Bladder Stone

Gall bladder is a small pouch that stores bile. It is a pear shaped pouch that is located on
the underside of the right portion of the liver. It can hold 45 milliliters of bile at a time.
Gallstones are a hard object that forms in the gall bladder, cyctic duct, hepatic duct or bile duct
(common bile duct). It is irregular in shape, and is usually about a size of a marble, and could be
much larger.

Gallstone composed of calcium salt, phospholipids, lecithin, bilirubin (a pigment),

bacteria and crystallized cholesterol. These products, with time, are filtered through the liver
and accumulate in the gall bladder.

Gallstones can be diagnosed mainly by:

* Ultrasonography - a use of high frequency sound waves that detect abnormalities

inside the body.

* Cholecystography - a use of X-ray after the patient swallowed a dye to outline the ducts and
gall bladder.
Signs/Symptoms:

Most people with gallstones (60%-80%) have no symptoms. In fact, they are usually
unaware that they have gallstones unless symptoms occur. These "silent gallstones" usually
require no treatment.
Symptoms usually occur as complications develop. The most common symptom is pain in the
right upper part of the abdomen. Because the pain comes in episodes, it is often referred to as
an "attack."

 Attacks may occur every few days, weeks, or months; they may even be separated by
years.
 The pain usually starts within 30 minutes after a fatty or greasy meal.
 The pain is usually severe, dull, and constant, and can last from one to five hours.
 It may radiate to the right shoulder or back.
 It occurs frequently at night and may awaken the person from sleep.
 The pain may make the person want to move around to seek relief, but many patients
prefer to lay still and wait for the attack to subside.

Other common symptoms of gallstones include the following:

 nausea and vomiting,
 fever,
 indigestion, belching, bloating,
 intolerance for fatty or greasy foods, and
 Jaundice (yellowing of the skin or the whites of the eyes).

Warning signs of a serious problem are fever, jaundice, and persistent pain.

MEDICAL NURSING THERAPY/DIET

MANAGEMENT:

* Drink 3 tbsp. of apple cider vinegar 3 times a day. You can dilute it in a glass of cold water
and you can also put honey to taste.
 * Take a bath with cold water up to the waist and then alternate with warm water when the
symptoms begin (colic). This will reduce abdominal inflammation.

* Drink a lot of water with cranberry juice and / or aloe vera juice. This is good to reduce
inflammation and will help expel the tiny stones toward the intestine.

* Person prone to gallstone are advised to have a diet low in fat and cholesterol.

* Eat food with a lot of fiber, fiber stimulate the digestive function and in turn produce more
bile juice which help to remove the stones from the intestine.

* Take lecithin, it is an important element to emulsify fats and cholesterol. Lecithin is like an
organic soap that the body uses to dissolve fats on the liver. It also prevents stones from being
formed in the gallbladder. Add 2 to 3 tsp. of granulated lecithin on a cooked food, juices and
salad. Do this for several days or until the stones are dislodged when you go to the bathroom.
Lecithin will slowly begin to work dissolving the cholesterol stones. You may keep drinking this
remedy for as long as needed. Drink a lot of pure water.

As an alternative treatment it is recommended:

* It is recommended doing fasting for 4 days with carrot, pineapple or grapefruit juice. It has
been shown that adding aloe vera increases the benefits (aloe vera contains many enzymes
which help the digestive function normally performed by bile secretions).

* On the fourth day of fasting at 7:00 pm, one should drink a cup of olive oil with a lot of lime
juice. On the next day drink 4 tablespoons of castor oil. After this, begin to eat vegetables for
several days increasing the amount little by little.

* If pain last for more than 4 hours consult your doctor, because this could be another
problem.

Medical Treatments:

* Removal of gall stone. You will have to stay in the hospital for 1 week.

* Laparoscope -an overnight stay in the hospital is recommended.

* Cholecystectomy - a surgical removal of gallbladder.

* Laparoscopic cholecystectomy - gallbladder is removed by means of instrument inserted

through a small incision in the abdomen.
 * Lithotripter -a device that produces shock waves that break stone into tiny fragments.

Education has a great role on lives of people. A proper education method is as important as giving education on a subject. Usually people have
education in schools. From past to now, schools have been very important in the area of education. By improvement of information technologies,
computers and internet became crucial elements of education. As a result, internet organizations built virtual schools in order to give courses on
the internet. Getting education at virtual schools is called “distance learning”. Shen (2003, p. 1) claims that distance learning is a kind of learning
method, that is performed by teacher and student, who are separated by means of time and location. Many people refuse to get education via the
internet. They think that unlike schools, distance learning does not provide social activities to students. A better alternative, for everyone, is
distance learning for three reasons.

Firstly, distance learning via the internet is more economical than schools education. In school education, buildings, desks, blackboards and other
needs of classrooms are necessary. Unlike school education, distance learning provides same education without these necessities. As a result,
distance learning organizations do not pay for these necessities. As preparing a virtual school is economical, distance learning organizations
provide courses with lower tuition fees. On the other hand, distance learning is also economical from the view of necessities of people who get
distance learning courses. For example, they don’t need to buy books, school uniform and pay money for transformation, food and
accommodation.

Secondly, distance learning satisfies us flexibility in setting our timetable and doing our job, other tasks and so on. As courses are performed by
special software in distance learning, we can attend to courses whenever we want. Moreover, distance learning via the internet enables us doing
our job and other tasks parallel to our education. For example, a doctor can attend to courses via the internet without hindering his/her job. And
also a mother can go on her education with caring her children and doing housework.

Finally, distance learning is accessible from any where by connecting to the internet. According to McGuire, “The course is available at virtually
any time or location and thus is accessible to a far broader range of students”(online, 1996). Accessibility of distance learning enable us attending
to courses from home by connecting to the internet. For example, disabled people can easily get education from their home. In addition, people
who perform their job in their offices, can attend to virtual courses from their office.

People who oppose to distance learning say that students became asocial by not having classmates. This idea can be seen reasonable at first
glance but people who get education by internet, react with his/her virtual classmates by internet as sending e-mail, chatting, writing on forums
and also do social activities with them in spare times as in schools. As distance learners save their times by not going to school, they prepare
social activities with their friends in their leisure times.

In conclusion, there are many advantages of distance learning via the internet. Researches on distance learning show that it is more efficient than
school education. Because of these advantages, distance learning via the internet will take place of school education in a few years.

DISTANCE LEARNING PROCESSES

Multimedia/hypermedia contexts such as the Web support constructivist approaches to learning, which are based on the belief that individuals
construct their own understanding of the world as they acquire knowledge and reflect on experiences. Dede (1996) describes how carefully
designed online learning can assist the construction of knowledge by showing learners the links among pieces of information and supporting
individual learning styles.

When Wiesenberg and Hutton (1995) conducted a continuing education program using computer conferencing, they found it necessitated two to
three times more delivery time. Learners appreciated the convenience of asynchronous communication, but many were anxious about putting
their written words "out there." The course was more democratic but less interactive than expected, and the instructors recommended giving
learners a better orientation to the online learning environment, providing technical support, and fostering self-directed learning and learning-to-
learn skills.

Eastmond (1995) highlights the ways that computer discussion both requires and facilitates learning-how-to-learn skills, such as locating and
accessing information resources, organizing information, conducting self-assessment, and collaborating. Adult learners in his study found the
following strategies critical to success in electronic learning: becoming comfortable with the technology, determining how often to go online,
dealing with textual ambiguity, processing information on or off line, seeking and giving feedback, and using one's learning style to personalize
the course.

THE SOCIAL NATURE OF DISTANCE LEARNING

A common stereotype is "the loneliness of the long distance learner" (Eastmond 1995, p. 46). Learning at a distance can be both isolating and
highly interactive, and electronic connectedness is a different kind of interaction than what takes place in traditional classrooms; some learners
are not comfortable with it. Lack of nonverbal cues can create misunderstanding, but communications protocols can be established and
relationships among learners developed. Because humans are involved, social norms do develop in cyberspace, but they require new
communications competencies (ibid.). Online courses often feature consensus building and group projects, through which learners can develop
skills in collaborating with distant colleagues and cooperating with diverse individuals. Such skills are increasingly needed in the global
workplace (Dede 1996).

Answering charges that computer learning environments cannot duplicate the community of the classroom, Cook (1995) argues that the
assumption of a sense of community in traditional classrooms may be false. If community is defined as shared interests, not geographic space,
electronic communities are possible. Wiesenberg and Hutton (1995) conclude that building a learning community is of critical importance to the
creation of a successful virtual classroom. Dede (1996) agrees that "to succeed, distributed learning must balance virtual and direct interaction in
sustaining communion among people" (p. 199).

STRATEGIES FOR DISTANCE LEARNING

Filipczak (1996) notes that DL on the Internet can be cheaper, faster, and usually more efficient than other learning modes, but not necessarily
more effective. As Dede (1996) puts it, "access to data does not automatically expand students' knowledge; the availability of information does
not intrinsically create an internal framework of ideas" (p. 199). To help learners make effective use of distance learning methods, skilled
facilitation is essential. Rohfeld and Hiemstra (1995) suggest ways to overcome the challenges of the electronic classroom: (1) establish the tone
early in the course; (2) to overcome the text-based nature of online discussion and to build group rapport and cohesion, introduce participants to
each other, match them with partners, and assign group projects; (3) offer training and guidelines to help learners acquire technical competence
and manage discussions; (4) provide a variety of activities, such as debates, polling, reflection, and critique; and (5) use learning contracts to
establish goals for participation. The following strategies are intended to make distance learning more effective (Bates 1995; Dede 1996;
Eastmond 1995; Filipczak 1995):

--Understand the technology's strengths and weaknesses

--Provide technical training and orientation

--Plan for technical failures and ensure access to technical support

--Foster learning-to-learn, self-directed learning, and critical reflection skills

--Develop information management skills to assist learners in selection and critical assessment

--Mix modes--e.g., combine e-mail discussion with audio/video methods to enhance the social aspect

--Structure learner-centered activities for both independent and group work that foster interaction

In the end, the word is still with us. The way it is transmitted and received is changing. Educators can play a role in the development of a "vital
form of literacy" (Dede 1996, p. 200): the transformation of information into knowledge. The choices they make can also help determine which
of these possibilities come to pass: (1) distance technologies as an add-on to existing institutions; (2) "knowledge in a box," impersonal,
individualized, and socially isolating; or (3) a networked learning society that keeps human relationships at the center of learning (Bates 1995).

REFERENCES

"Agricultural Education and Distance Education." AGRICULTURAL EDUCATION MAGAZINE 68, no. 11 (May 1996): 3-18, 21-23.

Bates, A. W. TECHNOLOGY, OPEN LEARNING AND DISTANCE EDUCATION. London: Routledge, 1995.