Flu
of infections and poisoning

You can catch flu many times because flu viruses change regularly. Your body won’t have a natural resistance to the new versions.



a sudden high temperature tiredness and weakness a headache general aches and pains a dry, chesty cough sore throat difficulty sleeping loss of appetite diarrhoea or tummy pain feeling sick and being sick chills a runny or blocked nose sneezing

The symptoms are similar for children. They may also get pain in their ear and be less active.

Symptoms

Some of the main symptoms of flu include:

a sudden high temperature tiredness and weakness a headache general aches and pains a dry, chesty cough sore throat difficulty sleeping loss of appetite diarrhoea or tummy pain feeling sick and being sick chills a runny or blocked nose sneezing

The symptoms are similar for children. They may also get pain in their ear and be less active.


The symptoms of flu usually develop 1 to 3 days after becoming infected. Most people will feel better within a week.

But, you may have a lingering cough and still feel very tired for a few more weeks.

Treatments

If you have flu, there are things you can do to help you recover more quickly.

Do rest get plenty of sleep keep warm drink lots of water to avoid dehydration take paracetamol or ibuprofen to lower your temperature and treat aches and pains stay off work or school until you feel better

Don’t do not take paracetamol and flu remedies that contain paracetamol at the same time

GPs don’t recommend antibiotics for flu. They won’t relieve your symptoms or speed up your recovery.

Preventions

Flu is spread by germs from coughs and sneezes. These can live on hands and surfaces for 24 hours.

You can help stop yourself catching flu or spreading it to others with good hygiene measures.

Do wash your hands regularly with soap and warm water clean surfaces like your computer keyboard, telephone and door handles regularly use tissues to cover your mouth and nose when you cough or sneeze bin used tissues as soon as possible avoid unnecessary contact with other people while you’re infectious stay off work or school until you’re feeling better

How to wash your hands properly Help to keep germs at bay by washing your hands properly. 

Alcohol and pregnancy
of pregnancy, looking after yourself and your baby

Treatments

For lots of women, stopping drinking when pregnant can be difficult – sometimes harder than they thought. The social pressure to have a drink can be huge and can make it harder to say no.

With the right support and a bit of planning, you can do it. Talking to your midwife is the first step towards getting the right support for you and your baby.

Food poisoning
of infections and poisoning

In most cases, food is contaminated by bacteria or a virus like:

campylobacter – the most common cause of food poisoning salmonella Escherichia coli (E. coli) norovirus listeria

Food Standards Scotland has further information about bacteria and viruses that can cause food poisoning.


campylobacter – the most common cause of food poisoning salmonella Escherichia coli (E. coli) norovirus listeria

Food Standards Scotland has further information about bacteria and viruses that can cause food poisoning.

Symptoms

Symptoms of food poisoning include:

feeling sick (nausea) being sick (vomiting) diarrhoea, which may contain blood or mucus stomach cramps and abdominal pain a lack of energy and weakness loss of appetite a high temperature of 38C or above (fever) aching muscles chills

The symptoms of food poisoning usually begin within 1 to 2 days of eating contaminated food. They can also start a few hours later or several weeks later.

Treatments

Do try to keep contact with vulnerable people to a minimum, for example the very young or elderly wash your hands with soap and warm water often clean surfaces, toilet seats, flush handles, basins and taps often make sure everyone in the household has their own towels and flannels wash the laundry of the infected person on the hottest washing machine setting

Preventions

Do try to keep contact with vulnerable people to a minimum, for example the very young or elderly wash your hands with soap and warm water often clean surfaces, toilet seats, flush handles, basins and taps often make sure everyone in the household has their own towels and flannels wash the laundry of the infected person on the hottest washing machine setting

Functional neurological disorder
of brain nerves and spinal cord

It’s often helpful to think of your brain as a computer. In someone who has FND, there’s no damage to the hardware, or structure, of the brain. It’s the software, or program running on the computer, that isn’t working properly.

The problems that cause FND are going on in a level of the brain that you cannot control. It includes symptoms like arm and leg weakness and seizures. Other symptoms like fatigue or pain are not directly caused by FND, but are often found alongside it.


The problems that cause FND are going on in a level of the brain that you cannot control. It includes symptoms like arm and leg weakness and seizures. Other symptoms like fatigue or pain are not directly caused by FND, but are often found alongside it.

Symptoms

FND can have many symptoms that can vary from person to person. Some people may have few symptoms, and some people may have many.

A diagnosis of FND should be made because you have one or more clinical features that a specialist can recognise as typical of FND. It shouldn’t be made just because scans or tests for other neurological conditions that have similar symptoms are normal.

What is a clinical feature? A clinical feature is a distinctive way that your symptom presents that is unique to FND. For example, it could be that your eyes close during seizures, or that limb weakness briefly disappears during certain physical tests. Clinical features are what specialists use to identify FND from other neurological conditions with similar symptoms.

Functional limb weakness Functional limb weakness is when a leg or an arm doesn’t work properly. In FND, this happens because of a problem with how the nervous system is functioning. It can cause a range of symptoms, including: problems walking heaviness down one side dropping things feeling like a limb isn’t part of you Functional limb weakness can often look a symptoms of a stroke or multiple sclerosis. If you have FND, any scans you have will show no damage to the brain to explain the weakness. A specialist will diagnose functional limb weakness based on specific clinical features (symptoms) they find when they examine you. Read more about functional limb weakness

Functional seizures A functional seizure (also called a dissociative seizure) is an episode where someone loses either their awareness of, or their ability to interact with, their surroundings. It may look like an epileptic seizure or a faint. A functional seizure can appear as: uncontrolled shaking suddenly going motionless and unresponsive staring without responding to surroundings Some people are aware that seizures are about to happen, while others experience them without warning. A specialist will ask you and your friends or family about what happens during a seizure, and will look at any video footage you can provide. They’ll use this evidence to decide if it’s epilepsy, a faint or a functional seizure. Read more about functional seizures

Functional tremor Tremor is uncontrollable shaking of part of the body. It’s most often found in the arms and legs. Functional tremor can come and go throughout the day, and change in speed and strength. A specialist will diagnose functional tremor based on specific features of your symptoms that they find when they examine you. Read more about functional tremor

Functional dystonia Functional dystonia is a type of muscle spasm. It causes a part of the body to become stuck in an unusual position. This can be for a short or a long period of time. Someone with functional dystonia will often present with curled fingers, a clenched hand, or an ankle that turns in. Read more about functional dystonia

Functional gait disorder Functional gait disorder describes the problems walking that you may experience as part of FND. You may find you have a dragging leg, that you feel unsteady when walking, or that you make excessive movements when walking. A specialist will diagnose functional gait disorder based on clinical features, like the way your walking changes when doing different activities. Read more about functional gait disorder

Functional facial spasm Functional facial spasm is when there are muscle spasms in the face. These can lead to problems like a narrowing of the eye or the pulling of the mouth or jaw upwards, downwards or to the side. Read more about functional facial spasm

Functional tics A tic is a fast repetitive movement or sound that happens suddenly. Functional tics can be a symptom of FND. Functional tics can look similar to the tics in Tourette’s syndrome. A specialist will look at the clinical features of your tics to make a diagnosis. It’s quite common to have both functional tics and Tourette’s syndrome.

Functional jerks and twitches A symptom of FND can be jerks or twitches, which is when someone makes sudden movements. Everyone experiences random jerks occasionally, like when you jolt awake as you’re falling asleep. In FND, however, these uncontrolled jerks and twitches can become much more frequent. Read more about functional jerks and twitches

Functional drop attacks Functional drop attacks are when someone falls to the ground suddenly, without losing consciousness. Read more about functional drop attacks

Functional sensory symptoms A symptom of FND can be numbness, pins and needles, or a feeling that a limb isn’t part of your body. Read more about functional sensory symptoms

Functional cognitive symptoms Problems with your memory or concentration can be a symptom of FND. You might find that you: lose track while doing things, for example being unable to remember why you went into a room go blank, for example when trying to recall your pin number lose track during conversations misplace important things, like your keys or phone forget words It’s normal to experience these things occasionally. For someone with functional cognitive symptoms, these things happen so often that they interfere with work and home life. The cognitive symptoms of FND can sometimes be mistaken for dementia. Specialists will look for features that are typical of functional cognitive symptoms when diagnosing FND. Read more about functional cognitive symptoms

Functional speech and swallowing difficulties Functional speech and swallowing difficulties can be a symptom of FND. You might experience: slurred speech a new stutter difficulties finding the right word unintentionally mixing words up whispering or hoarse speech (dysphonia) difficulty swallowing, including feeling like there’s something stuck in your throat A specialist will diagnose functional speech and swallowing difficulties based on specific features. Read more about functional speech and swallowing difficulties

Persistent postural perceptual dizziness (PPPD) PPPD (sometimes called functional dizziness, triple PD or 3PD) can be a symptom of FND. The dizziness in PPPD is typically experienced constantly, and gets worse while walking or in crowded environments. There are many causes of dizziness. Most people with PPPD have another cause of dizziness at the same time. A specialist will diagnose PPPD based on specific features when they assess you. Read more about PPPD

Functional visual symptoms Visual symptoms can be a part of FND. You may experience changes to your vision, like: blurred vision double vision photophobia (sensitivity to light) reduced vision A specialist will diagnose functional visual symptoms based on specific features that they find when they examine you. Read more about functional visual symptoms

Dissociative symptoms Dissociative symptoms are common in FND, although there are many other causes. These symptoms can be hard to describe, but are often described as feeling: that your body is disconnected from you that your body doesn’t belong to you disconnected from the world around you spaced out that you are floating that you are having an out-of-body experience there but not there You may also be able to hear what’s going on around you, but not be able to respond. These experiences are called dissociation, and can link into other FND symptoms. Read more about dissociative symptoms

There are other symptoms or conditions that are commonly associated with FND. These include:

chronic pain, including fibromyalgia, back and neck pain, and complex regional pain syndrome persistent fatigue sleep problems including insomnia (not sleeping enough) and hypersomnia (sleeping too much) migraines and other types of headache and facial pain irritable bowel syndrome and other problems with the function of your stomach and bowel anxiety and panic attacks depression post-traumatic stress disorder chronic urinary retention despite all tests being normal (which may be diagnosed as Fowlers syndrome) dysfunctional breathing

Causes

We know that the symptoms of FND happen because there’s a problem with how the brain is sending and receiving messages to itself and other parts of the body. Using research tools, scientists can see that certain circuits in the brain are not working properly in people with FND.

However, there’s still a lot of research to be done to understand how and why FND happens.

Why does FND happen?

FND can happen for a wide range of reasons. There’s often more than one reason, and the reasons can vary hugely from person to person.

Some of the reasons why the brain stops working properly in FND include:

the brain trying to get rid of a painful sensation a migraine or other neurological symptom the brain shutting down a part or all of the body in response to a situation it thinks is threatening

In some people, stressful events in the past or present can be relevant to FND. In others, stress is not relevant.

The risk of developing FND increases if you have another neurological condition.

Read more about how and why FND happens.

Diagnoses

When diagnosing FND, your healthcare provider will carry out an assessment to see if there are typical clinical features of FND.

Your healthcare provider may still choose to test for other diseases and conditions before diagnosing FND. This is because many conditions share the same symptoms and, in around a quarter of cases, FND is present alongside another neurological condition. Someone can have both FND and conditions like sciatica, carpal tunnel syndrome, epilepsy, or multiple sclerosis (MS).

The diagnosis of FND, however, should be given because you have the clinical features of FND. It shouldn’t be given just because there’s no evidence of other conditions or illnesses.

Because the symptoms of FND are not always there, your healthcare provider may ask you to video your symptoms. This will allow them to see what your symptoms look like.

Treatments

FND is a really variable condition. Some people have quite short-lived symptoms. Others can have them for many years.

There are treatments available that can manage and improve FND. These treatments are all forms of rehabilitation therapy, which aims to improve your ability to carry out every day activities. Many of these treatments are designed to ‘retrain the brain’. Some people with FND benefit a lot from treatment and may go into remission. Other people continue to have FND symptoms despite treatment.

Physiotherapy Specialised physiotherapy can be useful in treating FND. It helps to remind the body how it should move. It can also help you build up strength and stamina you may have lost. Read more about physiotherapy for FND

Occupational therapy Occupational therapy can be helpful in treating FND. An occupational therapist will work with you to plan your treatment goals, and gradually build your confidence and ability to reach them. Read more about occupational therapy for FND

Psychological therapy Psychological therapy can be helpful to many people with FND, even those without stress in their lives. It can help you gain a better understanding of FND and its relationship to your personal circumstances. There are specific psychological techniques which can help you gain better control over movement or seizure symptoms. Psychological therapy can also help you learn to manage low mood, anxiety and past traumatic events, as well as other psychological problems (if present). Not everyone with FND will need psychological therapy. Read more about psychological therapy for FND

Speech, language and swallowing therapy Speech and language therapists are available to help if you’re struggling with speaking or swallowing. They have a range of techniques to try, designed to help with specific problems. These might include helping you to shape certain sounds, or to practice breathing patterns as you try to talk. Read more about speech and language therapy for FND

Medication Medication can play a role in treating the some of the problems associated with FND, like pain, depression and anxiety. Your healthcare provider can help decide if medication is right for you. There are many types of medication that can make FND worse, including opiates like morphine, dihydrocodeine or codeine. It may be worth discussing your current medications with your healthcare provider.

Do not stop taking any medicine that’s been prescribed without checking with your GP or healthcare provider first. You could make yourself very ill.

Read more about treating FND

Fungal nail infection
of skin hair and nails

The infection develops slowly and causes the nail to become discoloured, thickened and distorted.

Toenails are more frequently affected than the fingernails.

The medical name for a fungal nail infection is onychomycosis.

A fungal nail infection can cause the nail to become thick, yellow and brittle.https://dermnetnz.org/


Toenails are more frequently affected than the fingernails.

The medical name for a fungal nail infection is onychomycosis.

A fungal nail infection can cause the nail to become thick, yellow and brittle.https://dermnetnz.org/


The medical name for a fungal nail infection is onychomycosis.

A fungal nail infection can cause the nail to become thick, yellow and brittle.https://dermnetnz.org/

Symptoms

A fungal nail infection may not cause any obvious symptoms at first.

As it progresses, the infection can cause:

discolouration of the nail – it may turn white, black, yellow or green thickening and distortion of the nail – it may become an unusual shape or texture and be difficult to trim pain or discomfort – particularly when using or placing pressure on the affected toe or finger brittle or crumbly nails – pieces may break off and come away completely

Sometimes the skin nearby may also become:

infected itchy cracked red swollen

Causes

Most fungal nail infections occur as a result of the fungi that cause athlete’s foot infecting the nails.

These fungi often live harmlessly on your skin, but they can sometimes multiply and lead to infections. The fungi prefer warm, dark and moist places like the feet.

You’re more likely to get a fungal nail infection if you:

don’t keep your feet clean and dry wear shoes that cause your feet to get hot and sweaty walk around barefoot in places where fungal infections can spread easily, like communal showers, locker rooms and gyms have damaged your nails have a weakened immune system have certain other health conditions, like diabetes, psoriasis or peripheral arterial disease

Fungal nail infections can be spread to other people, so you should take steps to avoid this if you have an infection.

Speak to your GP or pharmacist if: you’re bothered by the appearance of a nail with a fungal nail infection the fungal nail infection is causing problems like pain or discomfort

Treatments

A fungal nail infection is unlikely to get better without treatment. However, if you’re not bothered by it you might decide it’s not worth treating because treatment:

can take a long time can cause side effects isn’t always effective

Treatment may also be unnecessary in mild cases of fungal nail infection. It’s also unlikely to cause any further problems so you may feel it’s not worth treating.

For more severe or troublesome fungal nail infections, antifungal medication may be recommended.

Antifungal medication

Antifungal medication comes in tablets or a special paint you apply directly to the nail.

A small sample of the infected nail may need to be taken and sent off for testing before treatment starts, to confirm that you do have a fungal infection.

If the treatment is working, you should see a new healthy nail start to grow from the base of nail over the course of a few months. The old infected nail should begin to grow out and can be gradually clipped away.

Antifungal treatments are thought to be effective in treating about 60 to 80% of fungal nail infections. It can take between 6 and 18 months for the appearance of the affected nail to return to normal, and in some cases the nail may not look the same as before the infection.

Antifungal tablets Terbinafine and itraconazole are the 2 medicines most commonly prescribed for fungal nail infections. These usually need to be taken once or twice a day for several months to ensure the infection has completely cleared up. If you stop taking the medication too early, the infection may return. Possible side effects of antifungal tablets can include: headache itching diarrhoea loss of sense of taste a rash Antifungal tablets are currently not licensed to be sold over the counter. This is because these tablets have many listed side effects, contraindications and need to be taken for several months.

Antifungal nail paint If you prefer not to take antifungal tablets, your GP or pharmacist may suggest you try antifungal nail paint instead. Nail paint isn’t generally considered to be as effective as tablets because it can be difficult for it to reach the deeper layers of the nail. However, it doesn’t usually cause any side effects. Like antifungal tablets, antifungal nail paint also normally needs to be used for several months to ensure that the infection has cleared up.

Speak to your GP if new, healthy nail doesn’t start to grow after a few weeks of treatment. Keep using the treatment until your GP says you can stop. Stopping too early could result in the infection returning.

Softening and scraping away the nail

As it can take a long time for antifungal medication to work, some people may prefer to use a treatment that involves softening and removing infected parts of nail over a few weeks.

Treatment kits are available from pharmacies that contain a 40% urea paste, plasters and a scraping device. The paste softens the infected parts of the nail, allowing them to be scraped away so they can be gradually replaced with healthy nail.

To use the treatment:

wash the affected area and dry it thoroughly carefully apply the paste to the infected nails cover the nails with plasters and leave them for 24 hours wash the paste off the next day and scrape away the softened parts of the nail repeat this process each day for 2 to 3 weeks

Once no more infected parts of the nail can be removed, ask your pharmacist for antifungal nail paint to prevent re-infection as the nail regrows over the next few months.

Removing the nail

A procedure to remove affected nails completely isn’t usually necessary, but may be recommended if the infection is severe or painful and other treatments haven’t helped.

If your nail is surgically removed, a new nail should eventually grow back in its place. However, it could take a year or more for the nail to grow back completely.

Laser treatment

Laser treatment is a possible option if you have a fungal nail infection that’s particularly stubborn. The laser emits high doses of light energy, which are used to destroy the fungus.

Early research suggests the treatment may be helpful in treating fungal nail infections, but there’s currently not enough evidence to recommend it as a routine treatment.

If you want to try laser treatment, you’ll have to pay for it privately because it’s not available on the NHS. Be aware that the treatment may need to be repeated several times for up to a year, so it could get very expensive.

Preventions

Whether or not you decide to have treatment, you should still follow self-help advice to help stop the condition getting worse or spreading to others.

Do keep your hands and feet clean and drywear well-fitting shoes made of natural materials and clean cotton socks – these will allow your feet to “breathe”clip your nails to keep them short – don’t share clippers or scissors with other peoplereplace old footwear that could be contaminated with fungitreat athlete’s foot as soon as possible to avoid the infection spreading to your nailsensure your towels are washed regularlymake sure any equipment is properly sterilised between uses if you visit a nail salon

Don’t do not share towels and socks with other peopledo not walk around barefoot in public pools, showers, and locker rooms – special shower shoes are available to protect your feet

Gallbladder cancer
of cancer, cancer types in adults

There are a number of different types of gallbladder cancer, depending on the cells affected.

Over 85% of gallbladder cancers are adenocarcinoma, which means the cancer started in the gland cells lining the gallbladder.

Cancer that starts in the skin-like cells that line the gallbladder is known as squamous cell cancer.

The Cancer Research UK website has more information about the different types of gallbladder cancer.

Cancer of the gallbladder is more common in women than men, with around 7 out of 10 cases diagnosed in women. It’s also more common in older people, particularly those over 70 years of age.


Over 85% of gallbladder cancers are adenocarcinoma, which means the cancer started in the gland cells lining the gallbladder.

Cancer that starts in the skin-like cells that line the gallbladder is known as squamous cell cancer.

The Cancer Research UK website has more information about the different types of gallbladder cancer.

Cancer of the gallbladder is more common in women than men, with around 7 out of 10 cases diagnosed in women. It’s also more common in older people, particularly those over 70 years of age.


Cancer that starts in the skin-like cells that line the gallbladder is known as squamous cell cancer.

The Cancer Research UK website has more information about the different types of gallbladder cancer.

Cancer of the gallbladder is more common in women than men, with around 7 out of 10 cases diagnosed in women. It’s also more common in older people, particularly those over 70 years of age.

Symptoms

In the early stages, gallbladder cancer doesn’t cause symptoms, which means it could be at an advanced stage by the time it’s diagnosed.

Symptoms that occur at a later stage can include:

abdominal (stomach) pain feeling sick jaundice (yellowing of the skin and whites of the eyes)

These symptoms could be linked to a number of conditions and may not be related to gallbladder cancer. However, if you have these symptoms, you should speak to your GP so they can investigate what’s causing them.

Other possible symptoms of gallbladder cancer can include loss of appetite, unexplained weight loss and a swollen stomach.

Causes

In gallbladder cancer, abnormal cells grow within the gallbladder. It’s not known why this happens, but certain things are thought to increase your chances of developing the condition.

Gallbladder cancer is more common in older people, and your chances of developing it increase with age.

Lifestyle factors – such as obesity, smoking and an unhealthy diet – are believed to increase the risk of gallbladder cancer. However, there’s not enough evidence to show a firm link between diet and gallbladder cancer.

There are also a number of conditions that can increase your chances of developing gallbladder cancer. For example, gallstones, cholecystitis (inflammation of the gallbladder) and diabetes have been closely linked to the condition.

If you have a family history of gallstones, cholecystitis, or gallbladder cancer, you’re more likely to develop these conditions yourself.

The Cancer Research UK website has more information about the risks and causes of gallbladder cancer.

Diagnoses

Your GP will examine you and ask about your symptoms. If they suspect gallbladder cancer, they may refer you to a specialist, usually a gastroenterologist (a doctor who specialises in conditions of the digestive system).

The specialist will ask about your medical history and check to see whether the lymph glands in your neck and groin are swollen.

You may also have some initial tests, including:

blood tests an ultrasound scan a computerised tomography (CT) scan

If these tests reveal anything abnormal in or around your gallbladder, further tests may be arranged to help confirm whether you have gallbladder cancer. These may include:

an endoscopic retrograde cholangiopancreatography (ERCP) a magnetic resonance cholangiopancreatography (MRCP) biopsy and fine needle aspiration (FNA)

The Cancer Research UK website has more information about tests for gallbladder cancer.

Treatments

The main treatment for gallbladder cancer is surgery to remove the gallbladder and possibly some of the surrounding tissue.

Chemotherapy and radiotherapy are also sometimes used, either on their own or in combination with surgery.

The treatment programme that’s most suitable for you will depend on:

the type of gallbladder cancer you have the stage of your cancer your overall level of health

As with all cancers, the chances of survival depend on how far the condition has advanced when it is diagnosed.

The Cancer Research UK website has more information about treating gallbladder cancer and the stages and outlook for gallbladder cancer. 

Gallstones
of stomach liver and gastrointestinal tract

Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. In most cases they don’t cause any symptoms and don’t need to be treated.

However, if a gallstone becomes trapped in a duct (opening) inside the gallbladder it can trigger a sudden intense abdominal pain that usually lasts between 1 and 5 hours. This type of abdominal pain is known as biliary colic.

Some people with gallstones can also develop complications, such as inflammation of the gallbladder (cholecystitis), which can cause:

persistent pain jaundice  a fever

When gallstones cause symptoms or complications, it’s known as gallstone disease or cholelithiasis. Read more about:

symptoms of gallstones complications of gallstones

Symptoms

Most cases of gallstones don’t cause any symptoms. But if a gallstone blocks one of the bile ducts, it can cause sudden, severe abdominal pain, known as biliary colic.

Other symptoms may develop if the blockage is more severe or develops in another part of the digestive system.


In a small number of people, gallstones can cause more serious problems if they obstruct the flow of bile for longer periods or move into other organs (such as the pancreas or small bowel).

If this happens, you may develop:

a high temperature of 38C (100.4F) or above more persistent pain a rapid heartbeat yellowing of the skin and whites of the eyes (jaundice) itchy skin diarrhoea chills or shivering attacks confusion a loss of appetite

Doctors refer to this more severe condition as ‘complicated gallstone disease’.

Read more about the complications of gallstones.

Causes

Gallstones are thought to develop because of an imbalance in the chemical make-up of bile inside the gallbladder. In most cases the levels of cholesterol in bile become too high and the excess cholesterol forms into stones.

Gallstones are very common. It’s estimated that more than 1 in every 10 adults in the UK has gallstones, although only a minority of people develop symptoms.

You’re more at risk of developing gallstones if you’re:

overweight or obese  female, particularly if you’ve had children 40 or over (the risk increases as you get older)

Read more about:

causes of gallstones  preventing gallstones


Gallstones are thought to be caused by an imbalance in the chemical make-up of bile inside the gallbladder. Bile is a liquid produced by the liver to aid digestion.

It’s still unclear exactly what leads to this imbalance, but gallstones can form if:

there are unusually high levels of cholesterol inside the gallbladder (about 4 in every 5 gallstones are made up of cholesterol) there are unusually high levels of a waste product called bilirubin inside the gallbladder (about 1 in every 5 gallstones is made up of bilirubin)

These chemical imbalances cause tiny crystals to develop in the bile. These can gradually grow (often over many years) into solid stones that can be as small as a grain of sand or as large as a pebble.

Sometimes only 1 stone will form, but there are often several at the same time.

Diagnoses

Gallstones may be discovered during tests for a different condition, as they often don’t cause any symptoms.

If you do have symptoms of gallstones, make an appointment with your GP so they can try to identify the problem.


If your symptoms and test results suggest you may have gallstones, you’ll usually be referred for further tests. You may be admitted to hospital for tests the same day if your symptoms suggest you have a more severe form of gallbladder disease.

Ultrasound scan

Gallstones can usually be confirmed using an ultrasound scan, which uses high frequency sound waves to create an image of the inside of the body.

The type of ultrasound scan used for gallstones is similar to the scan used during pregnancy, where a small handheld device called a transducer is placed onto your skin and moved over your upper abdomen.

Sound waves are sent from the transducer, through your skin and into your body. They bounce back off the body tissues, forming an image on a monitor. This is a painless procedure that usually takes about 10 to 15 minutes to complete.

When gallstones are diagnosed, there may be some uncertainty about whether any stones have passed into the bile duct.

Gallstones in the bile duct are sometimes seen during an ultrasound scan. If they’re not visible but your tests suggest the bile duct may be affected, you may need an MRI scan or a cholangiography.

MRI scan

A magnetic resonance imaging (MRI) scan may be carried out to look for gallstones in the bile ducts. This type of scan uses strong magnetic fields and radio waves to produce detailed images of the inside of the body.

Cholangiography

A procedure called a cholangiography can give further information about the condition of your gallbladder.

A cholangiography uses a dye that shows up on X-rays. The dye may be injected into your bloodstream or injected directly into your bile ducts during surgery or using an endoscope passed through your mouth.

After the dye has been introduced, X-ray images are taken. They’ll reveal any abnormality in your bile or pancreatic systems. If your gallbladder and bile systems are working normally, the dye will be absorbed in the places it’s meant to go (your liver, bile ducts, intestines and gallbladder).

If a blockage is detected during this test, your doctor may try to remove it at this point using an endoscope. This is known as an endoscopic retrograde cholangio-pancreatography (ERCP). See treating gallstones for more information about ERCP.

CT scan

A computerised tomography (CT) scan may be carried out to look for any complications of gallstones, such as acute pancreatitis. This type of scan involves taking a series of X-rays from many different angles.

CT scans are often done in an emergency to diagnose severe abdominal pain.

Treatments

Treatment is usually only necessary if gallstones are causing:

symptoms – such as abdominal pain complications – such as jaundice or acute pancreatitis

In these cases, keyhole surgery to remove the gallbladder may be recommended. This procedure, known as a laparoscopic cholecystectomy, is relatively simple to perform and has a low risk of complications.

You can lead a perfectly normal life without a gallbladder. Your liver will still produce bile to digest food, but the bile will just drip continuously into the small intestine, rather than build up in the gallbladder.

Read more about:

treating gallstones diagnosing gallstones


If you think you may be experiencing biliary colic, you should make an appointment with your GP.

Contact your GP immediately for advice if you develop:

jaundice abdominal pain lasting longer than eight hours a high temperature and chills abdominal pain so intense that you can’t find a position to relieve it

If it’s not possible to contact your GP immediately, phone your local out-of-hours or NHS 24’s 111 service.


Your treatment plan for gallstones depends on how the symptoms are affecting your daily life.

If you don’t have any symptoms, a policy of ‘active monitoring’ is often recommended. This means you won’t receive immediate treatment, but you should let your GP know if you notice any symptoms.

As a general rule, the longer you go without symptoms, the less likely it is that your condition will get worse.

You may need treatment if you have a condition that increases your risk of developing complications, such as:

scarring of the liver (cirrhosis) high blood pressure inside the liver – this is known as portal hypertension and is often a complication of alcohol-related liver disease diabetes

Treatment may also be recommended if a scan shows high levels of calcium inside your gallbladder, as this can lead to gallbladder cancer in later life.

If you have episodes of abdominal pain (biliary colic), treatment depends on how the pain affects your daily activities. If the episodes are mild and infrequent, you may be prescribed painkillers to control further episodes and given advice about eating a healthy diet to help control the pain.

If your symptoms are more severe and occur frequently, surgery to remove the gallbladder is usually recommended.

The gallbladder isn’t an essential organ and you can lead a perfectly normal life without one. Some people may experience symptoms of bloating and diarrhoea after eating fatty or spicy food. If certain foods do trigger symptoms, you may wish to avoid them in the future.

Preventions

From the limited evidence available, changes to your diet and losing weight (if you’re overweight) may help prevent gallstones.

Complications

A small number of people with gallstones may develop serious problems if the gallstones cause a severe blockage or move into another part of the digestive system.

Ganglion cyst
of muscle bone and joints, conditions

Ganglion cysts are soft, gel-like masses that often change size.

They tend to be smooth and round, and are:

the most common type of swelling in the hand, wrist and foot harmless and can safely be left alone

If you have a ganglion, try to stay positive. There’s a lot you can do to help yourself.

Symptoms

If you have a ganglion cyst the swelling can become noticeable, but often there are no symptoms at all.

Sometimes a ganglion can cause pain and limit movement in your joint. Some people are also concerned about the cysts appearance.

Most symptoms settle with time.

Causes

A ganglion cyst starts when the fluid leaks out of a joint or tendon tunnel and forms a swelling beneath the skin.

The cause of the leak is generally unknown, but may be due to trauma or underlying arthritis.

How common are they?

Ganglion cysts are 3 times more common in women than men between 20 and 40 years of age.

Types of ganglion cysts

Ganglions can form:

at the back of the wrist – these typically occur in young adults and often disappears without treatment at the front of the wrist – these may occur in young adults, but also seen in older people with arthritis at the base of the finger (flexor tendon sheath) – these usually occur in young adults on the finger (mucoid cyst) – these usually occur in middle-aged or older people

Approximately 80% of ganglions are found in the wrist.

Diagnoses

To diagnose a ganglion cyst, a healthcare professional will ask you about it and examine your wrist and hand.

Giving a diagnosis is usually straightforward. However, scans may be helpful if the diagnosis is uncertain.

Treatments

About 50% of ganglions disappear on their own without treatment. In the early stages you should wait to see if this happens.

You won’t need treatment unless the cyst is painful.

Medication

Many people take medication to cope with their pain and symptoms, and help them remain active.

You may be prescribed pain medication to ease the pain. Make sure you take any medication as prescribed, and get advice from a GP, pharmacist or suitably trained healthcare professional.

Surgery

If the ganglion hasn’t reduced in size after 6 months or is causing significant functional difficulty and/or pain, you may be referred for further help and possible surgery.

Surgery is considered if it causes significant pain or restricts movement in your joint. However, there’s a chance it will come back even after surgery.

Ganglion cyst at the back of the wrist

Draining this ganglion can reduce the swelling but it often returns.

Problems after surgery include:

persistent pain loss of wrist movement painful trapping of nerve branches in the scar

There’s a 10% chance of it coming back again after surgery.

Ganglion cyst at the front of the wrist

Draining this ganglion may be useful, but it can be dangerous as the cyst is often close to the artery at the wrist (where you can feel the pulse).

Problems after surgery include:

persistent pain loss of wrist movement trapping of nerve branches in the scar

For these reasons, many surgeons advise against operating on these cysts.

There’s a 30 to 40% chance of it coming back again after surgery.

Ganglion cyst at the base of the finger

These ganglions feel like a dried pea at the base of the finger, and can cause pain when gripping.

Problems after surgery include:

persistent pain loss of finger movement painful trapping of nerve branches in the scar

There’s a small chance of it coming back again after surgery.

Finger ganglion cyst

These ganglions are associated with wearing out of the end joint of a finger. Pressure from the cyst may cause a furrow in the fingernail. Occasionally the cyst fluid leaks through the thin overlying skin.

Problems after surgery include:

infection stiffness and pain from the worn out joint

There’s a 10% chance of it coming back again after surgery.

Gastroenteritis
of stomach liver and gastrointestinal tract

It affects people of all ages, but is particularly common in young children.

Most cases in children are caused by a virus called rotavirus. Cases in adults are usually caused by norovirus (the ‘winter vomiting bug’) or bacterial food poisoning.

Gastroenteritis can be very unpleasant, but it usually clears up by itself within a week. You can normally look after yourself or your child at home until you’re feeling better.

Try to avoid going to your GP, as gastroenteritis can spread to others very easily. Phone 111 or your GP if you’re concerned or need any advice.


Most cases in children are caused by a virus called rotavirus. Cases in adults are usually caused by norovirus (the ‘winter vomiting bug’) or bacterial food poisoning.

Gastroenteritis can be very unpleasant, but it usually clears up by itself within a week. You can normally look after yourself or your child at home until you’re feeling better.

Try to avoid going to your GP, as gastroenteritis can spread to others very easily. Phone 111 or your GP if you’re concerned or need any advice.


Gastroenteritis can be very unpleasant, but it usually clears up by itself within a week. You can normally look after yourself or your child at home until you’re feeling better.

Try to avoid going to your GP, as gastroenteritis can spread to others very easily. Phone 111 or your GP if you’re concerned or need any advice.

Symptoms

The main symptoms of gastroenteritis are:

sudden, watery diarrhoea feeling sick vomiting, which can be projectile a mild fever

Some people also have other symptoms, such as a loss of appetite, an upset stomach, aching limbs and headaches.

The symptoms usually appear up to a day after becoming infected. They typically last less than a week, but can sometimes last longer.

Treatments

You don’t normally need to see your GP if you think you have gastroenteritis, as it should get better on its own.

Visiting your GP practice can put others at risk, so it’s best to phone 111 or your GP if you’re concerned or feel you need advice.

Phone 111 or your GP practice if: you have symptoms of severe dehydration, such as persistent dizziness, only passing small amounts of urine or no urine at all, or if you’re losing consciousness you have bloody diarrhoea you’re vomiting constantly and are unable to keep down any fluids you have a fever over 38C (100.4F) your symptoms haven’t started to improve after a few days in the last few weeks you’ve returned from a part of the world with poor sanitation you have a serious underlying condition, such as kidney disease, inflammatory bowel disease or a weak immune system, and have diarrhoea and vomiting

Your GP may suggest sending off a sample of your poo to a laboratory to check what’s causing your symptoms. Antibiotics may be prescribed if this shows you have a bacterial infection.

Preventions

It’s not always possible to avoid getting gastroenteritis, but following this advice can help stop it spreading.

Do stay off work, school or nursery until at least 48 hours after the symptoms have passed – you or your child should also avoid visiting anyone in hospital during this timeensure you and your child wash your hands frequently and thoroughly with soap and water, particularly after using the toilet and before preparing food – don’t rely on alcohol hand gels, as they’re not always effectivedisinfect any surfaces or objects that could be contaminated – it’s best to use a bleach-based household cleanerwash contaminated items of clothing or bedding separately on a hot washflush away any poo or vomit in the toilet or potty and clean the surrounding areapractice good food hygiene: make sure food is properly refrigerated, always cook your food thoroughly, and never eat food that is past its use-by date

Don’t do not rely on alcohol hand gels, as they’re not always effectivedon’t share towels, flannels, cutlery or utensils while you or your child is ill

Take extra care when travelling to parts of the world with poor sanitation, as you could pick up a stomach bug. For example, you may need to boil tap water before drinking it.

Young children can have the rotavirus vaccination when they’re 2 to 3 months old, which can reduce their risk of developing gastroenteritis.

Gastro-oesophageal reflux disease (GORD)
of stomach liver and gastrointestinal tract

Gastro-oesophageal reflux disease (GORD) is a common condition, where acid from the stomach leaks up into the oesophagus (gullet).

It usually occurs as a result of the ring of muscle at the bottom of the oesophagus becoming weakened. Read more about the causes of GORD.

GORD causes symptoms such as heartburn and an unpleasant taste in the back of the mouth. It may just be an occasional nuisance for some people, but for others it can be a severe, lifelong problem.

GORD can often be controlled with self-help measures and medication. Occasionally, surgery to correct the problem may be needed.

This topic focuses on GORD in adults.

Symptoms

Symptoms of GORD can include:

heartburn (an uncomfortable burning sensation in the chest that often occurs after eating) acid reflux (where stomach acid comes back up into your mouth and causes an unpleasant, sour taste) oesophagitis (a sore, inflamed oesophagus) bad breath bloating and belching feeling or being sick pain when swallowing and/or difficulty swallowing

Read more about the symptoms of GORD.


The main symptoms of gastro-oesophageal reflux disease (GORD) are heartburn and acid reflux.


If you have GORD, you may also experience:

a sore, inflamed oesophagus (oesophagitis) bad breath bloating and belching feeling or being sick difficulty swallowing, which may feel like a piece of food is stuck low down in your throat pain when swallowing  a sore throat and hoarseness a persistent cough or wheezing, which may be worse at night tooth decay and gum disease

If you also have asthma, the symptoms may get worse as a result of stomach acid irritating your airways.

Causes

Gastro-oesophageal reflux disease (GORD) is usually caused by the ring of muscle at the bottom of the oesophagus (gullet) becoming weakened.

Normally, this ring of muscle opens to let food into your stomach and closes to stop stomach acid leaking back up into your oesophagus.

But for people with GORD, stomach acid is able to pass back up into the oesophagus. This causes symptoms of GORD, which can include heartburn and acid reflux.

It’s not always clear what causes this ring of muscle to become weakened, but certain things can increase the risk of it happening.

Diagnoses

Your GP will often be able to diagnose gastro-oesophageal reflux disease (GORD) based on your symptoms.

They may prescribe medication to treat it without needing to carry out any tests. Read more about treating GORD.


You’ll usually only need to be referred for tests in hospital if:

your GP is unsure whether you have GORD your symptoms are persistent, severe or unusual prescription medications aren’t controlling your symptoms your GP thinks you might benefit from surgery you have signs of a potentially more severe condition, such as difficulty swallowing or unexplained weight loss

Tests can help to confirm the diagnosis of GORD, check for other possible causes of your symptoms and determine whether you may be suitable for surgery.


Tests you may have include:

an endoscopy a barium swallow or barium meal test manometry 24-hour pH monitoring blood tests

Endoscopy

An endoscopy is a procedure where the inside of your body is examined using an endoscope, which is a long, thin, flexible tube with a light and camera at one end.

The endoscope will be gently inserted into your mouth and down your throat. The procedure is usually carried out while you’re awake, but you may be given a sedative to help you relax.

The camera can show if the surface of your oesophagus (gullet) has been damaged by stomach acid, although this doesn’t happen to everyone with GORD.

Barium swallow or barium meal

A barium swallow, or barium meal, is a test to assess your swallowing ability and look for any blockages or abnormalities in your oesophagus.

You are first given some barium solution, then some X-rays are taken. Barium is a harmless substance that shows up clearly on X-rays as it passes through your digestive system.

You’ll be asked not to eat anything for a few hours before the procedure. Afterwards, you’ll be able to eat and drink normally, although you may need to drink more water to help flush the barium out of your body.

Manometry

Manometry is used to assess how well the ring of muscle at the end of your oesophagus is working, by measuring the pressure in your oesophagus.

This can rule out other possible causes of your symptoms and can help determine whether surgery would be suitable.

During the procedure, a small tube will be passed up your nose and then down into your oesophagus. The tube contains pressure sensors that can detect the pressure in the oesophagus.

24-hour pH monitoring

It may be necessary to measure the acidity level (pH) in your oesophagus to confirm a diagnosis of GORD if nothing is found during an endoscopy.

The acidity level is measured over 24 hours, using a thin tube containing a sensor that’s passed up your nose and down your oesophagus. This is usually connected to a recording device worn on your waist.

You’ll be asked to press a button on the recorder every time you become aware of your symptoms and to record your symptoms in a diary. You should eat as you normally would during the test to ensure an accurate result.

Blood tests

Sometimes a blood test may be carried out to check for anaemia, which can be a sign of internal bleeding. 

Treatments

Visit your GP if you’re worried about your symptoms, or if:

you have symptoms several times a week over-the-counter medications aren’t helping your symptoms are severe you have difficulty swallowing you have possible signs of a more serious problem, such as persistent vomiting, vomiting blood or unexplained weight loss

Your GP will usually be able to diagnose GORD based on your symptoms, although they may refer you for some tests.

Read more about diagnosing GORD.


The main treatments for GORD are:

self-help measures – this includes eating smaller but more frequent meals, avoiding any foods or drinks that trigger your symptoms, raising the head of your bed, and keeping to a healthy weight over-the-counter medicines – ask your pharmacist to recommend an antacid or an alginate stronger prescription medicines – including proton-pump inhibitors (PPIs) and H2-receptor antagonists (H2RAs)

You may only need to take medication when you experience symptoms, although long-term treatment may be needed if the problem continues.

Surgery to stop stomach acid leaking into your oesophagus may be recommended if medication isn’t helping, or you don’t want to take medication on a long-term basis.

Read more about the treatments for GORD.


You’ll usually only need to be referred for tests in hospital if:

your GP is unsure whether you have GORD your symptoms are persistent, severe or unusual prescription medications aren’t controlling your symptoms your GP thinks you might benefit from surgery you have signs of a potentially more severe condition, such as difficulty swallowing or unexplained weight loss

Tests can help to confirm the diagnosis of GORD, check for other possible causes of your symptoms and determine whether you may be suitable for surgery.


Heartburn and gastro-oesophageal reflux disease (GORD) can often be treated with self-help measures and over-the-counter medicines.

If these don’t help, your GP can prescribe stronger medication or refer you to a specialist to discuss whether surgery may be an option.

Complications

If you have GORD for a long time, stomach acid can damage your oesophagus and cause further problems.

These include:

ulcers (sores) on the oesophagus – these may bleed and make swallowing painful the oesophagus becoming scarred and narrowed – this can make swallowing difficult and may require an operation to correct it changes in the cells lining the oesophagus (Barrett’s oesophagus) – very occasionally, oesophageal cancer can develop from these cells, so you may need to be closely monitored

Read more about the complications of GORD.


A number of possible complications can occur as a result of having gastro-oesophageal reflux disease (GORD) for a long time.