American Medical Association Family Medical Guide - American Medical Association [525]
The symptoms of a cholangiocarcinoma include clay-colored stool, jaundice (yellowing of the skin and the whites of the eyes; see page 785), itching of the skin, pain in the right upper abdomen that may radiate to the back, loss of appetite, weight loss, and fever and chills.
Diagnosis
If you have symptoms of a cholangiocarcinoma, your doctor will order tests to look for a tumor or obstruction in a bile duct. You may have an imaging procedure such as a CT scan (see page 112) or ultrasound (see page 111) of your abdomen, or ERCP (see above). In ERCP, the doctor passes a flexible viewing tube (called an endoscope) down your esophagus, through the stomach, and into the small intestine, and introduces a dye into the bile duct. Another diagnostic imaging test is a percutaneous transhepatic cholangiogram (PTCA), in which a thin, flexible needle is inserted through the skin of the upper right side of your abdomen into the liver. An X-ray machine called a fluoroscope transmits images onto a monitor, guiding the doctor as he or she inserts the needle into the bile duct and injects a dye that will show up on the monitor and reveal any abnormalities in the bile duct. If a tumor shows up on an image, the doctor will take a sample of cells during the ERCP or PTCA for examination in the laboratory to look for cancer cells and to confirm the diagnosis.
Treatment
The treatment for cholangiocarcinoma is to surgically remove the tumor, if possible, which can result in a cure if the cancer is found early and has not spread from the bile duct. Sometimes chemotherapy (see page 23) or radiation therapy (see page 23) is given after surgery to reduce the risk of a recurrence. If the tumor cannot be removed surgically, treatment to clear the obstruction in the bile duct and relieve symptoms may be done through an endoscope. Radiation therapy, sometimes combined with chemotherapy, may follow.
Cholecystitis
In cholecystitis, the gallbladder becomes inflamed and swollen, usually because a gallstone has become lodged in the cystic duct, blocking the flow of bile from the gallbladder into the intestine and causing severe pain (called biliary colic). In rare cases, the inflammation results from an infection that has spread from the intestine to the gallbladder. Three out of four people who have cholecystitis have had previous gallbladder problems.
Site of pain in cholecystitis
Symptoms
If a gallstone becomes lodged in the cystic duct, a person will have severe pain in the upper right area of the abdomen that can spread around to the back and to the right shoulder blade. As cholecystitis develops, a person’s temperature rises and he or she will probably have nausea and vomiting. If the condition is not treated, jaundice (yellowing of the skin and whites of the eyes; see page 785) can develop.
Diagnosis and Treatment
To diagnose cholecystitis, a doctor may recommend tests such as a hepatobiliary (HIDA) scan, a test that can detect an obstruction in the cystic duct by tracking a radioactive dye through the liver and gallbladder. In HIDA, a nuclear scanner takes multiple pictures of the abdominal area, and a radiologist (a doctor who specializes in the use of radiation for diagnosis or treatment) interprets the pictures.
If you have cholecystitis, you probably will be admitted to the hospital and given fluids intravenously (through a vein) to provide you with nutrients and fluid. You will not be allowed to eat or drink for a few days, and you will be given a pain reliever and antibiotics by injection or intravenously. If you have cholecystitis, the doctor will recommend that you have your gallbladder removed. In severe cases, removal is done within a day or two after a person is admitted to the hospital. However, some doctors prefer to wait until the inflammation has subsided.
Laparoscopic cholecystectomy (see page 795) is the procedure used most often to treat cholecystitis. In an alternative treatment, gallstones may be dissolved by long-term treatment with drugs. However, this treatment has several disadvantages. For example, you