Dipak-001/mistril_dataset huggingface dataset:
user: What are the treatments for What I need to know about Hirschsprung Disease ?

assistant: Pull-through Procedure
                
HD is treated with surgery called a pull-through procedure. A surgeon removes the segment of the large intestine lacking nerve cells and connects the healthy segment to the anus. The pull-through procedure is usually done soon after diagnosis.
                
Ostomy surgery
                
An ostomy allows stool to leave the body through an opening in the abdomen. Although most children with HD do not need an ostomy, a child who has been very sick from HD may need an ostomy to get better before the pull-through procedure.
                
For ostomy surgery, the surgeon first takes out the diseased segment of the large intestine. The end of the healthy intestine is moved to an opening in the abdomen where a stoma is created. A stoma is created by rolling the intestines end back on itself, like a shirt cuff, and stitching it to the abdominal wall. An ostomy pouch is attached to the stoma and worn outside the body to collect stool. The pouch will need to be emptied several times each day.
                

                
If the surgeon removes the entire large intestine and connects the small intestine to the stoma, the surgery is called an ileostomy. If the surgeon leaves part of the large intestine and connects it to the stoma, the surgery is called a colostomy.
                
Later, during the pull-through procedure, the surgeon removes the stoma and closes the abdomen with stitches.
user: What to do for What I need to know about Hirschsprung Disease ?

assistant: - Hirschsprung disease (HD) is a disease of the large intestine that causes severe constipation or intestinal obstruction. People with HD are born with it.  - The large intestine, which includes the colon and rectum, is the last part of the digestive tract.  - The cause of HD is unclear. HD is not caused by anything a mother did while pregnant.  - The main symptoms of HD are constipation or intestinal obstruction, usually appearing shortly after birth.  - Newborns with HD almost always fail to have their first bowel movement within 48 hours after birth.  - HD is diagnosed based on symptoms and test results.  - HD is treated with surgery called a pull-through procedure.  - A child who has been very sick from HD may need an ostomy to get better before the pull-through procedure.  - Most children pass stool normally after the pull-through procedure.  - People with HD can suffer from an infection of the intestines, called enterocolitis, before or after surgery.  - If you have a child with HD, your chance of having more children with HD is greater.
user: What is (are) Gallstones ?

assistant: Gallstones are hard particles that develop in the gallbladder. The gallbladder is a small, pear-shaped organ located in the upper right abdomenthe area between the chest and hipsbelow the liver.
                
Gallstones can range in size from a grain of sand to a golf ball. The gallbladder can develop a single large gallstone, hundreds of tiny stones, or both small and large stones. Gallstones can cause sudden pain in the upper right abdomen. This pain, called a gallbladder attack or biliary colic, occurs when gallstones block the ducts of the biliary tract.
user: What is (are) Gallstones ?

assistant: The biliary tract consists of the gallbladder and the bile ducts. The bile ducts carry bile and other digestive enzymes from the liver and pancreas to the duodenumthe fi rst part of the small intestine.
                
The liver produces bilea fl uid that carries toxins and waste products out of the body and helps the body digest fats and the fat-soluble vitamins A, D, E, and K. Bile mostly consists of cholesterol, bile salts, and bilirubin. Bilirubin, a reddish-yellow substance, forms when hemoglobin from red blood cells breaks down. Most bilirubin is excreted through bile.
                

                

                
The bile ducts of the biliary tract include the hepatic ducts, the common bile duct, the pancreatic duct, and the cystic duct. The gallbladder stores bile. Eating signals the gallbladder to contract and empty bile through the cystic duct and common bile duct into the duodenum to mix with food.
user: What causes Gallstones ?

assistant: Imbalances in the substances that make up bile cause gallstones. Gallstones may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Scientists do not fully understand why these imbalances occur. Gallstones also may form if the gallbladder does not empty completely or often enough.
                
The two types of gallstones are cholesterol and pigment stones:
                
- Cholesterol stones, usually yellow-green in color, consist primarily of hardened cholesterol. In the United States, more than 80 percent of gallstones are cholesterol stones.1  - Pigment stones, dark in color, are made of bilirubin.
user: Who is at risk for Gallstones? ?

assistant: Certain people have a higher risk of developing gallstones than others:2
                
- Women are more likely to develop gallstones than men. Extra estrogen can increase cholesterol levels in bile and decrease gallbladder contractions, which may cause gallstones to form. Women may have extra estrogen due to pregnancy, hormone replacement therapy, or birth control pills.   - People over age 40 are more likely to develop gallstones than younger people.   - People with a family history of gallstones have a higher risk.   - American Indians have genetic factors that increase the amount of cholesterol in their bile. In fact, American Indians have the highest rate of gallstones in the United Statesalmost 65 percent of women and 30 percent of men have gallstones.   - Mexican Americans are at higher risk of developing gallstones.
                
Other factors that affect a persons risk of gallstones include2
                
- Obesity. People who are obese, especially women, have increased risk of developing gallstones. Obesity increases the amount of cholesterol in bile, which can cause stone formation.   - Rapid weight loss. As the body breaks down fat during prolonged fasting and rapid weight loss, the liver secretes extra cholesterol into bile. Rapid weight loss can also prevent the gallbladder from emptying properly. Low-calorie diets and bariatric surgerysurgery that limits the amount of food a person can eat or digestlead to rapid weight loss and increased risk of gallstones.   - Diet. Research suggests diets high in calories and refi ned carbohydrates and low in fi ber increase the risk of gallstones. Refi ned carbohydrates are grains processed to remove bran and germ, which contain nutrients and  fiber. Examples of refi ned carbohydrates include white bread and white rice.   - Certain intestinal diseases. Diseases that affect normal absorption of nutrients, such as Crohns disease, are associated with gallstones.   - Metabolic syndrome, diabetes, and insulin resistance. These conditions increase the risk of gallstones. Metabolic syndrome also increases the risk of gallstone complications. Metabolic syndrome is a group of traits and medical conditions linked to being overweight or obese that puts people at risk for heart disease and type 2 diabetes.
                
More information about these conditions is provided in the NIDDK health topic, Insulin Resistance and Prediabetes.
                
- cirrhosisa condition in which the liver slowly deteriorates and malfunctions due to chronic, or long lasting, injury   - infections in the bile ducts   - severe hemolytic anemiasconditions in which red blood cells are continuously broken down, such as sickle cell anemia
user: What are the symptoms of Gallstones ?

assistant: Many people with gallstones do not have symptoms. Gallstones that do not cause symptoms are called asymptomatic, or silent, gallstones. Silent gallstones do not interfere with the function of the gallbladder, liver, or pancreas.
                
If gallstones block the bile ducts, pressure increases in the gallbladder, causing a gallbladder attack. The pain usually lasts from 1 to several hours.1 Gallbladder attacks often follow heavy meals, and they usually occur in the evening or during the night.
                
Gallbladder attacks usually stop when gallstones move and no longer block the bile ducts. However, if any of the bile ducts remain blocked for more than a few hours, complications can occur. Complications include infl ammation, or swelling, of the gallbladder and severe damage or infection of the gallbladder, bile ducts, or liver.
                
A gallstone that becomes lodged in the common bile duct near the duodenum and blocks the pancreatic duct can cause gallstone pancreatitisin flammation of the pancreas.
                
Left untreated, blockages of the bile ducts or pancreatic duct can be fatal.
user: What is (are) Gallstones ?

assistant: People who think they have had a gallbladder attack should notify their health care provider. Although these attacks usually resolve as gallstones move, complications can develop if the bile ducts remain blocked.
                
People with any of the following symptoms during or after a gallbladder attack should see a health care provider immediately:
                
- abdominal pain lasting more than 5 hours   - nausea and vomiting   - fevereven a low-grade feveror chills  - yellowish color of the skin or whites of the eyes, called jaundice   - tea-colored urine and light-colored stools
                
These symptoms may be signs of serious infection or infl ammation of the gallbladder, liver, or pancreas.
user: What to do for Gallstones ?

assistant: Factors related to eating, diet, and nutrition that increase the risk of gallstones include
                
- obesity   - rapid weight loss   - diets high in calories and refi ned carbohydrates and low in fi ber
                
People can decrease their risk of gallstones by maintaining a healthy weight through proper diet and nutrition.
                
Ursodiol can help prevent gallstones in people who rapidly lose weight through low-calorie diets or bariatric surgery. People should talk with their health care provider or dietitian about what diet is right for them.
user: What to do for Gallstones ?

assistant: - Gallstones are hard particles that develop in the gallbladder.  - Imbalances in the substances that make up bile cause gallstones. Gallstones may form if bile contains too much cholesterol, too much bilirubin, or not enough bile salts. Scientists do not fully understand why these imbalances occur.   - Women, people over age 40, people with a family history of gallstones, American Indians, and Mexican Americans have a higher risk of developing gallstones.   - Many people with gallstones do not have symptoms. Gallstones that do not cause symptoms are called asymptomatic, or silent, gallstones.  - If gallstones block the bile ducts, pressure increases in the gallbladder, causing a gallbladder attack.  - Gallbladder attacks often follow heavy meals, and they usually occur in the evening or during the night.  - Gallstone symptoms may be similar to those of other conditions.   - If gallstones are not causing symptoms, treatment is usually not needed. However, if a person has a gallbladder attack or other symptoms, a health care provider will usually recommend treatment.   - The usual treatment for gallstones is surgery to remove the gallbladder. If a person cannot undergo surgery, nonsurgical treatments may be used to dissolve cholesterol gallstones. A health care provider may use endoscopic retrograde cholangiopancreatography (ERCP) to remove stones in people who cannot undergo surgery or to remove stones from the common bile duct in people who are about to have gallbladder removal surgery.   - The gallbladder is not an essential organ, which means a person can live normally without a gallbladder. Once the gallbladder is removed, bile  flows out of the liver through the hepatic and common bile ducts and directly into the duodenum, instead of being stored in the gallbladder.
user: What is (are) Smoking and the Digestive System ?

assistant: The digestive system is made up of the gastrointestinal (GI) tractalso called the digestive tractand the liver, pancreas, and gallbladder. The GI tract is a series of hollow organs joined in a long, twisting tube from the mouth to the anus. The hollow organs that make up the GI tract are the mouth, esophagus, stomach, small intestine, large intestinewhich includes the colon and rectumand anus. Food enters the mouth and passes to the anus through the hollow organs of the GI tract. The liver, pancreas, and gallbladder are the solid organs of the digestive system. The digestive system helps the body digest food, which includes breaking food down into nutrients the body needs. Nutrients are substances the body uses for energy, growth, and cell repair.
user: Who is at risk for Smoking and the Digestive System? ?

assistant: Smoking has been found to increase the risk of cancers of the3
                
- mouth  - esophagus  - stomach  - pancreas
                
3
                
,
                
4
                
,
                
5
                
- liver  - colon  - rectum
                
More information about the link between smoking and cancers of the digestive system can be found on the National Cancer Institute website at www.cancer.gov/cancertopics/tobacco/smoking.
user: What is (are) Smoking and the Digestive System ?

assistant: Smoking contributes to many common disorders of the digestive system, such as heartburn and gastroesophageal reflux disease (GERD), peptic ulcers, and some liver diseases. Smoking increases the risk of Crohns disease, colon polyps, and pancreatitis, and it may increase the risk of gallstones.
user: What to do for Smoking and the Digestive System ?

assistant: Eating, diet, and nutrition can play a role in causing, preventing, and treating some of the diseases and disorders of the digestive system that are affected by smoking, including heartburn and GERD, liver diseases, Crohns disease, colon polyps, pancreatitis, and gallstones. More information about eating, diet, and nutrition and these conditions can be found on the Digestive Diseases A-Z list.
user: What to do for Smoking and the Digestive System ?

assistant: - Smoking has been found to increase the risk of cancers of the mouth, esophagus, stomach, and pancreas. Research suggests that smoking may also increase the risk of cancers of the liver, colon, and rectum.  - Smoking increases the risk of heartburn and gastroesophageal reflux disease (GERD).  - Smoking increases the risk of peptic ulcers.  - Smoking may worsen some liver diseases, including primary biliary cirrhosis and nonalcoholic fatty liver disease (NAFLD).  - Current and former smokers have a higher risk of developing Crohns disease than people who have never smoked.  - People who smoke are more likely to develop colon polyps.  - Smoking increases the risk of developing pancreatitis.  - Some studies have shown that smoking may increase the risk of developing gallstones. However, research results are not consistent and more study is needed.  - Quitting smoking can reverse some of the effects of smoking on the digestive system.
user: What is (are) Graves' Disease ?

assistant: Graves disease, also known as toxic diffuse goiter, is the most common cause of hyperthyroidism in the United States. Hyperthyroidism is a disorder that occurs when the thyroid gland makes more thyroid hormone than the body needs.
                
The Thyroid
                
The thyroid is a 2-inch-long, butterfly-shaped gland in the front of the neck below the larynx, or voice box. The thyroid makes two thyroid hormones, triiodothyronine (T3 ) and thyroxine (T4 ). T3 is made from T4 and is the more active hormone, directly affecting the tissues. Thyroid hormones circulate throughout the body in the bloodstream and act on virtually every tissue and cell in the body.
                
Thyroid hormones affect metabolism, brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, and cholesterol levels. Hyperthyroidism causes many of the bodys functions to speed up.
                
Thyroid hormone production is regulated by another hormone called thyroid-stimulating hormone (TSH), which is made by the pituitary gland in the brain. When thyroid hormone levels in the blood are low, the pituitary releases more TSH. When thyroid hormone levels are high, the pituitary responds by decreasing TSH production.
                

                
Autoimmune Disorder
                
Graves disease is an autoimmune disorder. Normally, the immune system protects the body from infection by identifying and destroying bacteria, viruses, and other potentially harmful foreign substances. But in autoimmune diseases, the immune system attacks the bodys own cells and organs.
                
With Graves disease, the immune system makes an antibody called thyroid-stimulating immunoglobulin (TSI)sometimes called TSH receptor antibodythat attaches to thyroid cells. TSI mimics TSH and stimulates the thyroid to make too much thyroid hormone. Sometimes the TSI antibody instead blocks thyroid hormone production, leading to conflicting symptoms that may make correct diagnosis more difficult.
user: What are the symptoms of Graves' Disease ?

assistant: People with Graves disease may have common symptoms of hyperthyroidism such as
                
- nervousness or irritability  - fatigue or muscle weakness  - heat intolerance  - trouble sleeping  - hand tremors  - rapid and irregular heartbeat  - frequent bowel movements or diarrhea  - weight loss  - goiter, which is an enlarged thyroid that may cause the neck to look swollen and can interfere with normal breathing and swallowing
                
A small number of people with Graves disease also experience thickening and reddening of the skin on their shins. This usually painless problem is called pretibial myxedema or Graves dermopathy.
                
In addition, the eyes of people with Graves disease may appear enlarged because their eyelids are retractedseem pulled back into the eye socketsand their eyes bulge out from the eye sockets. This condition is called Graves ophthalmopathy (GO).
user: What is (are) Graves' Disease ?

assistant: Graves ophthalmopathy is a condition associated with Graves disease that occurs when cells from the immune system attack the muscles and other tissues around the eyes.
                
The result is inflammation and a buildup of tissue and fat behind the eye socket, causing the eyeballs to bulge out. Rarely, inflammation is severe enough to compress the optic nerve that leads to the eye, causing vision loss.
                
Other GO symptoms are
                
- dry, gritty, and irritated eyes  - puffy eyelids  - double vision  - light sensitivity  - pressure or pain in the eyes  - trouble moving the eyes
                
About 25 to 30 percent of people with Graves disease develop mild GO, and 2 to 5 percent develop severe GO.1 This eye condition usually lasts 1 to 2 years and often improves on its own.
                
GO can occur before, at the same time as, or after other symptoms of hyperthyroidism develop and may even occur in people whose thyroid function is normal. Smoking makes GO worse.
                
1Yeung SJ, Habra MA, Chiu AC. Graves disease. emedicine website. emedicine.medscape.com/article/120619-overview. Updated 2010. Accessed December 10, 2011.
user: How to diagnose Graves' Disease ?

assistant: Health care providers can sometimes diagnose Graves disease based only on a physical examination and a medical history. Blood tests and other diagnostic tests, such as the following, then confirm the diagnosis.
                
TSH test. The ultrasensitive TSH test is usually the first test performed. This test detects even tiny amounts of TSH in the blood and is the most accurate measure of thyroid activity available.
                
T3 and T4 test. Another blood test used to diagnose Graves disease measures T3 and T4 levels. In making a diagnosis, health care providers look for below-normal levels of TSH, normal to elevated levels of T4, and elevated levels of T3.
                
Because the combination of low TSH and high T3 and T4 can occur with other thyroid problems, health care providers may order other tests to finalize the diagnosis. The following two tests use small, safe doses of radioactive iodine because the thyroid uses iodine to make thyroid hormone.
                
Radioactive iodine uptake test. This test measures the amount of iodine the thyroid collects from the bloodstream. High levels of iodine uptake can indicate Graves disease.
                
Thyroid scan. This scan shows how and where iodine is distributed in the thyroid. With Graves disease the entire thyroid is involved, so the iodine shows up throughout the gland. Other causes of hyperthyroidism such as nodulessmall lumps in the glandshow a different pattern of iodine distribution.
                
TSI test. Health care providers may also recommend the TSI test, although this test usually isnt necessary to diagnose Graves disease. This test, also called a TSH antibody test, measures the level of TSI in the blood. Most people with Graves disease have this antibody, but people whose hyperthyroidism is caused by other conditions do not.
                
More information about testing for thyroid problems is provided in the NIDDK health topic, Thyroid Tests.
user: What are the treatments for Graves' Disease ?

assistant: Treatment for Graves disease can sometimes affect pregnancy. After treatment with surgery or radioactive iodine, TSI antibodies can still be present in the blood, even when thyroid levels are normal. If a pregnant woman has received either of these treatments prior to becoming pregnant, the antibodies she produces may travel across the placenta to the babys bloodstream and stimulate the fetal thyroid.
                
A pregnant woman who has been treated with surgery or radioactive iodine should inform her health care provider so her baby can be monitored for thyroid-related problems later in the pregnancy. Pregnant women may safely be treated with anti-thyroid medications.
                
For more information about pregnancy and anti-thyroid medications, see Medications under the section titled How is Graves disease treated?More information about pregnancy and thyroid disease is provided in the NIDDK health topic, Pregnancy and Thyroid Disease.
user: What to do for Graves' Disease ?

assistant: Experts recommend that people eat a balanced diet to obtain most nutrients. More information about diet and nutrition is provided by the National Agricultural Library available at www.nutrition.gov.
                
Dietary Supplements
                
Iodine is an essential mineral for the thyroid. However, people with autoimmune thyroid disease may be sensitive to harmful side effects from iodine. Taking iodine drops or eating foods containing large amounts of iodinesuch as seaweed, dulse, or kelpmay cause or worsen hyperthyroidism. More information about iodine is provided by the National Library of Medicine in the fact sheet, Iodine in diet, available at www.nlm.nih.gov/medlineplus.
                
Women need more iodine when they are pregnantabout 250 micrograms a daybecause the baby gets iodine from the mothers diet. In the United States, about 7 percent of pregnant women may not get enough iodine in their diet or through prenatal vitamins.3 Choosing iodized saltsalt supplemented with iodineover plain salt and prenatal vitamins containing iodine will ensure this need is met.
                
To help ensure coordinated and safe care, people should discuss their use of dietary supplements, such as iodine, with their health care provider. Tips for talking with health care providers are available through the National Center for Complementary and Integrative Health.
                
3 Zimmerman MB. Iodine deficiency in pregnancy and the effects of maternal iodine supplementation on the offspring: a review. American Journal of Clinical Nutrition. 2009;89(2):668S672S.