American Medical Association Family Medical Guide - American Medical Association [524]
Laparoscopic cholecystectomy
Before disconnecting the gallbladder from the cystic artery (which supplies the gallbladder with blood) and the cystic duct (which connects the gallbladder to the liver), a surgeon puts clips on the artery and duct to close them off. After the artery and duct to the gallbladder are closed off, the surgeon uses tiny scissors to cut the artery and duct to free the gallbladder. He or she then removes the gallbladder through a small incision below the navel.
Symptoms and Diagnosis
A person can have primary sclerosing cholangitis for years before symptoms develop. When symptoms appear, they can include itching (caused by a buildup of bile salts in the skin), fatigue, and jaundice (yellowing of the skin and whites of the eyes; see page 785). If the bile ducts become infected, a person also can have a fever and chills.
Primary sclerosing cholangitis is diagnosed using an imaging procedure called cholangiography, in which a dye is injected into the bile ducts and an X-ray is taken to obtain a picture of the bile ducts.
Treatment
The treatment of primary sclerosing cholangitis includes medication to relieve itching, antibiotics to treat infections, and vitamin supplements (because the disease can reduce the body’s ability to absorb some vitamins, particularly A, D, and K). In some cases, a blockage in the common bile duct is opened using ERCP (see above), in which a wire coil (stent) is inserted into the blockage and expanded; the stent remains in place to keep the duct open. If the liver starts to fail, the doctor may recommend a liver transplant (see page 790).
ERCP
To diagnose and treat various problems in the bile ducts including tumors, cysts, and narrowing, doctors use a procedure called endoscopic retrograde cholangiopancreatography (ERCP). It is also used to help evaluate jaundice (yellowing of the skin and whites of the eyes; see page 785). In ERCP, an endoscope (a flexible viewing tube) is passed down the esophagus, through the stomach, and into the duodenum. After introducing a dye into the bile and pancreatic ducts, the doctor can see any stones or other abnormalities in the duct on an X-ray image. If a stone is found, a tiny device can be passed through the endoscope to grab the stone (or stones) and pull it out or to dislodge it and allow it to pass through the newly enlarged opening to the duodenum.
The procedure takes from 30 minutes to 2 hours. If the procedure is done for diagnosis only, you will be able to leave the hospital after the sedative wears off, probably after about 1 to 2 hours. If a gallstone was removed or other treatment given, you may need to stay overnight in the hospital. Possible complications of ERCP, which are rare, include pancreatitis (inflammation of the pancreas; see page 798), infection, bleeding, and perforation of the duodenum.
ERCP
In ERCP, a flexible viewing tube (endoscope) is passed into a person’s mouth and esophagus through the stomach into the first part of the small intestine (duodenum). After locating the stone on an X-ray image, the doctor inserts an instrument through the endoscope into the bile duct to grab the stone and pull it out or to dislodge it and allow it to pass on its own into the duodenum.
Cholangiocarcinoma
A cholangiocarcinoma is a relatively rare cancerous growth in one of the bile ducts, which carry the digestive fluid bile from the liver to the small intestine. Cholangiocarcinomas, which can develop anywhere along a bile duct, are usually slow-growing and don’t cause symptoms until they block the duct. The tumors occur in people of both sexes equally and are usually diagnosed after age 65. People who have primary sclerosing cholangitis (see page 794) or another disorder that causes chronic inflammation in the bile ducts have an increased risk of developing cholangiocarcinomas.
Symptoms