Tag Archives: Gallbladder

Cholangitis

Definition:
Cholangitis is an infection of the common bile duct, the tube that carries bile from the liver to the gallbladder and intestines. Bile is a liquid made by the liver that helps digest food.

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Cholangitis can be life-threatening, and is regarded as a medical emergency. Characteristic symptoms include yellow discoloration of the skin or whites of the eyes, fever, abdominal pain, and in severe cases, low blood pressure and confusion. Initial treatment is with intravenous fluids and antibiotics, but there is often an underlying problem (such as gallstones or narrowing in the bile duct) for which further tests and treatments may be necessary, usually in the form of endoscopy to relieve obstruction of the bile duct.
Symptoms:
The following symptoms may occur:

*Pain on the upper right side or upper middle part of the abdomen. It may also be felt in the back or below the right shoulder blade. The pain may come and go and feel sharp, cramp-like, or dull.

*Fever and chills

*Dark urine and clay-colored stools

*Nausea and vomiting

*Yellowing of the skin (jaundice), which may come and go
Physical examination findings typically include jaundice and right upper quadrant tenderness.Charcot’s triad is a set of three common findings in cholangitis: abdominal pain, jaundice, and fever. This was assumed in the past to be present in 50–70% of cases, although more recently the frequency has been reported as 15–20%.Reynolds’ pentad includes the findings of Charcot’s triad with the presence of septic shock and mental confusion. This combination of symptoms indicates worsening of the condition and the development of sepsis, and is seen less commonly still.

In the elderly, the presentation may be atypical; they may directly collapse due to septicemia without first showing typical features. Those with an indwelling stent in the bile duct (see below) may not develop jaundice.

Causes:
Cholangitis is most often caused by a bacterial infection. This can occur when the duct is blocked by something, such as a gallstone or tumor. The infection causing this condition may also spread to the liver.

Bile duct obstruction, which is usually present in acute cholangitis, is generally due to gallstones. 10–30% of cases, however, are due to other causes such as benign stricturing (narrowing of the bile duct without an underlying tumor), postoperative damage or an altered structure of the bile ducts such as narrowing at the site of an anastomosis (surgical connection), various tumors (cancer of the bile duct, gallbladder cancer, cancer of the ampulla of Vater, pancreatic cancer, cancer of the duodenum), anaerobic organisms such as Clostridium and Bacteroides (especially in the elderly and those who have undergone previous surgery of the biliary system). Parasites which may infect the liver and bile ducts may cause cholangitis; these include the roundworm Ascaris lumbricoides and the liver flukes Clonorchis sinensis, Opisthorchis viverrini and Opisthorchis felineus. In people with AIDS, a large number of opportunistic organisms has been known to cause AIDS cholangiopathy, but the risk has rapidly diminished since the introduction of effective AIDS treatment. Cholangitis may also complicate medical procedures involving the bile duct, especially ERCP. To prevent this, it is recommended that those undergoing ERCP for any indication receive prophylactic (preventative) antibiotics.

The presence of a permanent biliary stent (e.g. in pancreatic cancer) slightly increases the risk of cholangitis, but stents of this type are often needed to keep the bile duct patent under outside pressure

Diagnosis:
Routine blood tests show features of acute inflammation (raised white blood cell count and elevated C-reactive protein level), and usually abnormal liver function tests (LFTs). In most cases the LFTs will be consistent with obstruction: raised bilirubin, alkaline phosphatase and ?-glutamyl transpeptidase. In the early stages, however, pressure on the liver cells may be the main feature and the tests will resemble those in hepatitis, with elevations in alanine transaminase and aspartate transaminase.

Blood cultures are often performed in people with fever and evidence of acute infection. These yield the bacteria causing the infection in 36% of cases, usually after 24–48 hours of incubation. Bile, too, may be sent for culture during ERCP (see below). The most common bacteria linked to ascending cholangitis are gram-negative bacilli: Escherichia coli (25–50%), Klebsiella (15–20%) and Enterobacter (5–10%). Of the gram-positive cocci, Enterococcus causes 10–20%.

You may have the following tests to look for blockages:

*Abdominal ultrasound

*Endoscopic retrograde cholangiopancreatography (ERCP)

*Magnetic resonance cholangiopancreatography (MRCP)

*Percutaneous transhepatic cholangiogram (PTCA)

*You may also have the following blood tests:

#Bilirubin level
#Liver enzyme levels
#Liver function tests
#White blood count (WBC)
Treatment:
Quick diagnosis and treatment are very important.Antibiotics to cure infection is the first treatment done in most cases. ERCP or other surgical procedure is done when the patient is stable.Patients who are very ill or are quickly getting worse may need surgery right away.

Cholangitis requires admission to hospital. Intravenous fluids are administered, especially if the blood pressure is low, and antibiotics are commenced. Empirical treatment with broad-spectrum antibiotics is usually necessary until it is known for certain which pathogen is causing the infection, and to which antibiotics it is sensitive. Combinations of penicillins and aminoglycosides are widely used, although ciprofloxacin has been shown to be effective in most cases, and may be preferred to aminoglycosides because of fewer side effects. Metronidazole is often added to specifically treat the anaerobic pathogens, especially in those who are very ill or at risk of anaerobic infections. Antibiotics are continued for 7–10 days. Drugs that increase the blood pressure (vasopressors) may also be required to counter the low blood pressure.
Prognosis:
Acute cholangitis carries a significant risk of death, the leading cause being irreversible shock with multiple organ failure (a possible complication of severe infections). Improvements in diagnosis and treatment have led to a reduction in mortality: before 1980, the mortality rate was greater than 50%, but after 1980 it was 10–30%. Patients with signs of multiple organ failure are likely to die unless they undergo early biliary drainage and treatment with systemic antibiotics. Other causes of death following severe cholangitis include heart failure and pneumonia.

Risk Factors:
Risk factors include a previous history of gallstones, sclerosing cholangitis, HIV, narrowing of the common bile duct, and, rarely, travel to countries where you might catch a worm or parasite infection.

Risk factors indicating an increased risk of death include older age, female gender, a history of liver cirrhosis, biliary narrowing due to cancer, acute renal failure and the presence of liver abscesses. Complications following severe cholangitis include renal failure, respiratory failure (inability of the respiratory system to oxygenate blood and/or eliminate carbon dioxide), cardiac arrhythmia, wound infection, pneumonia, gastrointestinal bleeding and myocardial ischemia (lack of blood flow to the heart, leading to heart attacks).

Prevention:
Treatment of gallstones, tumors, and infestations of parasites may reduce the risk for some people. A metal or plastic stent that is placed in the bile system may be needed to prevent the infection from returning.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/000290.htm
http://en.wikipedia.org/wiki/Ascending_cholangitis

Artemisia capillaries

 

Botanical Name : Artemisia capillaries
Family: Asteraceae
Genus: Artemisia
Species: A. scoparia
Order: Asterales

Common Names : Yin Chen Hao
English Name:Capillary Wormwood Herb
Pin Yin Name:Yin Chen

Other Pin Yin Name:Mian Yin Chen,Bai Hao,Rong Hao,Song Mao Ai,Ma Xian,Po Po Hao,Ye Lan Hao

Habitat :Artemisia capillaries  is native to E. Asia – China, Japan, Korea, Manchuria. It  grows on  the grassy thickets, and along rivers and seashores, C. and S. Japan. Humid slopes, hills, terraces, roadsides and river banks at elevations of 100 – 2700 metres in China.

Description:
Artemisia capillaris is a deciduous perennial herb or subshrub.Stem erect height 0.5 to 1 m,root woody,surface color yellow brown,vertical stripin,branches;seedling covered with brown silk hair,hairless when grow up.Bottom Leaf split wide and short,covered with short silky foliage;middle leaf split long and slim as hair,1mm width;top leaf split into 3 parts or no split,no hair.capitulum small and numerous,flower color yellow,pipe like,outer layer 3 to 5 bud,female,fertible,inner layer bisexual 5 to 7,infertility.Fruit long round shape width 0.8mm,hairless.Flowering during September to October.The flowers are hermaphrodite (have both male and female organs) and are pollinated by Wind.and the seeds ripen from Sep to October.

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The plant prefers light (sandy) and medium (loamy) soils and requires well-drained soil.The plant prefers neutral and basic (alkaline) soils..It can grow in semi-shade (light woodland) or no shade.It requires dry or moist soil and can tolerate drought.The plant can tolerates strong winds but not maritime exposure.

Cultivation:
An easily grown plant, succeeding in a well-drained circumneutral or slightly alkaline loamy soil, preferring a sunny position. Established plants are drought tolerant. Plants are longer lived, more hardy and more aromatic when they are grown in a poor dry soil. This species is probably not hardy in all parts of Britain, it tolerates temperatures down to at least -5°c. Plants in this genus are notably resistant to honey fungus. Members of this genus are rarely if ever troubled by browsing deer.

Propagation :
Seed – surface sow from late winter to early summer in a greenhouse. When large enough to handle, prick the seedlings out into individual pots and plant them out in the summer. Cuttings of half-ripe wood, July/August in a frame. Division in spring or autumn.

Edible Uses :
Edible Parts: Leaves.

Leaves and stems – soaked and boiled

Medicinal Uses:
Antibacterial;  Anticholesterolemic;  Antiviral;  CholagogueDiureticFebrifugeHepatic;  Vasodilator.

Yin Chen Hao has been used in Chinese herbal medicine for over 2,000 years. It is considered to be a bitter and cooling herb, clearing “damp heat” from the liver and gall ducts and relieving fevers. It is an effective remedy for liver problems, being specifically helpful in treating hepatitis with jaundice. Modern research has confirmed that the plant has a tonic and strengthening effect upon the liver, gallbladder and digestive system. The leaves and young shoots are antibacterial, anticholesterolemic, antiviral, cholagogue, diuretic, febrifuge and vasodilator. An infusion is used internally in the treatment of jaundice, hepatitis, gall bladder complaints and feverish illnesses. Externally it has been applied in the form of a plaster for treating headaches. The plant is harvested in late spring and can be dried for later use. Yin Chen Hao is contraindicated for pregnant women

Yin chen hao is an effective remedy for liver problems, being specifically helpful for treating hepatitis with jaundice.  Traditional Chinese medicine holds that it is bitter and cooling, clearing “damp heat” from the liver and gall ducts and relieving fevers.  Yin chen hao is also anti-inflammatory and diuretic.  It was formerly used in a plaster for headaches.  Research indicates that yin chen hao has a tonic and strengthening effect on the liver and gallbladder and digestive system.  It is an effective remedy for liver problems, being specifically helpful in treating hepatitis with jaundice.    An infusion of the young shoots is used internally in the treatment of jaundice, hepatitis, gall bladder complaints and feverish illnesses. Externally it has been applied in the form of a plaster for treating headaches.

Known Hazards : Although no reports of toxicity have been seen for this species, skin contact with some members of this genus can cause dermatitis or other allergic reactions in some people.

Disclaimer:The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider

Resources:
http://www.mdidea.com/products/proper/proper05203.html
http://www.pfaf.org/user/Plant.aspx?LatinName=Artemisia+capillaris
http://www.herbnet.com/Herb%20Uses_UZ.htm

http://library.thinkquest.org/25983/4.%20Capillaris.htm

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Endoscopic Retrograde Cholangiopancreatography (ERCP)

Definition:
Endoscopic retrograde cholangiopancreatography  (ERCP) enables the physician to diagnose problems in the liver, gallbladder, bile ducts, and pancreas. The liver is a large organ that, among other things, makes a liquid called bile that helps with digestion. The gallbladder is a small, pear-shaped organ that stores bile until it is needed for digestion. The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. These ducts are sometimes called the biliary tree. The pancreas is a large gland that produces chemicals that help with digestion and hormones such as insulin.
click & see the pictures
This procedure uses x-rays and an endoscope to see inside your digestive system and diagnose problems such as tumors, gallstones, and inflammation in your liver, gallbladder, bile ducts, or pancreas. Your doctor might use the test to investigate the cause of jaundice, upper abdominal pain, or unexplained weight loss.

Why an ERCP is Performed
ERCP is most commonly performed to diagnose conditions of the pancreas or bile ducts, and is also used to treat those conditions. It is used to evaluate symptoms suggestive of disease in these organs, or to further clarify abnormal results from blood tests or imaging tests such as ultrasound or CT scan. The most common reasons to do ERCP include abdominal pain, weight loss, jaundice, or an ultrasound or CT scan that shows stones or a mass in these organs.

ERCP may be used before or after gallbladder surgery to assist in the performance of that operation. Bile duct stones can be diagnosed and removed with an ERCP. Tumors, both cancerous and noncancerous, can be diagnosed and then treated with indwelling plastic tubes that are used to bypass a blockage of the bile duct. Complications from gallbladder surgery can also sometimes be diagnosed and treated with ERCP.

In patients with suspected or known pancreatic disease, ERCP will help determine the need for surgery or the best type of surgical procedure to be performed. Occasionally, pancreatic stones can be removed by ERCP.

If the exam shows a gallstone or narrowing of the ducts, the physician can insert instruments into the scope to remove or relieve the obstruction. Also, tissue samples (biopsy) can be taken for further testing.

Preparation
For a week before the test, don’t take aspirin or other NSAIDs because they can irritate the stomach lining and increase your chance of bleeding during the procedure. Also tell the doctor if you are taking blood-thinning medicines or any diabetes medications. People with heart valve problems may also have to take antibiotics before the procedure. Avoid eating or drinking anything for eight hours before the test because it needs to be done on an empty stomach.

Tell your doctor if you are allergic to iodine, which is used for the procedure. Arrange for someone to drive you home because the medication given during the test will make you drowsy.

Your stomach and duodenum must be empty for the procedure to be accurate and safe. You will not be able to eat or drink anything after midnight the night before the procedure, or for 6 to 8 hours beforehand, depending on the time of your procedure. Also, the physician will need to know whether you have any allergies, especially to iodine, which is in the dye. You must also arrange for someone to take you home—you will not be allowed to drive because of the sedatives. The physician may give you other special instructions.

What can be expected during ERCP
Your throat will be sprayed with a local anesthetic before the test begins to numb your throat and prevent gagging. You will be given medication intravenously to help you relax during the examination. While you are lying in a comfortable position on an X-ray table, an endoscope will be gently passed through your mouth, down your esophagus, and into your stomach and duodenum. The procedure usually lasts about an hour. The endoscope does not interfere with your breathing. Most patients fall asleep during the procedure or find it only slightly uncomfortable. You may feel temporarily bloated during and after the procedure due to the air used to inflate the duodenum. As X-ray contrast material is injected into the pancreatic or bile ducts, you may feel some minor discomfort.

What happens when the test is performed
The test is performed by a specially trained gastroenterologist either in the doctor’s office or in a hospital. You are usually given a sedative through an IV line. You wear a hospital gown for the procedure and lie on your side against a backrest on an x-ray table. If you wear dentures, remove them. A local anesthetic is sprayed into your throat to prevent you from having a gag reflex (choking feeling) when the endoscope is placed inside. The endoscope is about a third of an inch in diameter and 21/2 feet long with a light on the end. It also has holes at the end that allow your doctor to pump air into your intestine, squirt fluid, and suck out liquid or air.

You are asked to swallow at the moment the tube is placed into your throat. This helps guide the endoscope into your esophagus.You are likely to feel pressure against your throat while the tube is in place and you might experience a “full” feeling in your stomach. The doctor or doctor’s assistant gently advances the tube until it reaches your duodenum, the first part of the small intestine.

Next, the doctor inserts a slender tube, called a cannula, through the endoscope, and places the tip of the cannula into the bile duct or the pancreatic duct. These ducts are natural tubes of tissue that drain liquids out of the liver and pancreas. Once the tip of the cannula is lodged inside one of these ducts, the doctor injects contrast dye (usually iodine) through the cannula. The dye can be seen by x-rays, so it lights up the ducts clearly on an x-ray image, showing any obstruction (such as from gallstones or cancer) or unusual widening of the ducts (indicating an obstruction in the past). It also can light up the gallbladder, which connects to the bile duct, and helps the doctor to visualize the liver and pancreatic tissue around the ducts.

Depending on what the x-rays show, the doctor may undertake different interventions using tools operated through the endoscope. The doctor can remove gallstones or take biopsies of suspicious tissue. He or she can prop open narrowed bile ducts with a stent, a tube-shaped object that can be inserted through the scope. Depending on what is done, the test can take from 30 minutes to two hours.

Risk Factors:Complications are rare. One possibility is aspiration-accidentally inhaling saliva into the lungs – which can cause pneumonia. Other risks include inflammation of the pancreas, infection, and bleeding. Injury to the lining of the stomach, esophagus, or intestine, as well as abdominal pain and fever, can also occur.

Possible complications of ERCP include pancreatitis (inflammation of the pancreas), infection, bleeding, and perforation of the duodenum. Except for pancreatitis, such problems are uncommon.
You may have tenderness or a lump where the sedative was injected, but that should go away in a few days.

Time required to do the test:
ERCP takes 30 minutes to 2 hours. You may have some discomfort when the physician blows air into the duodenum and injects the dye into the ducts. However, the pain medicine and sedative should keep you from feeling too much discomfort. After the procedure, you will need to stay at the hospital for 1 to 2 hours until the sedative wears off. The physician will make sure you do not have signs of complications before you leave. If any kind of treatment is done during ERCP, such as removing a gallstone, you may need to stay in the hospital overnight.

What happens after the Test is over
You will be monitored in the endoscopy area for 1-2 hours until the effects of the sedatives have worn off. Your throat may be a little sore for a day or two. You will be able to resume your diet and take your routine medication after you leave the endoscopy area, unless otherwise instructed.

Your surgeon will usually inform you of your test results on the day of the procedure. Biopsy results take several days to return, and you should make arrangements with your surgeon to get these results. The effects of sedation may make you forget what you were instructed after the procedure. Call your surgeon’s office for the results.

Resources:
https://www.health.harvard.edu/fhg/diagnostics/endoscopic-retrograde-cholangiopancreatography.shtml
http://digestive.niddk.nih.gov/ddiseases/pubs/ercp/
http://www.alabangmedicalcenter.ph/patientscorner/ERCP.htm

Cholangiocarcinoma

 

Alternative Names: Bile duct cancer

Definition: Cholangiocarcinoma is a cancerous (malignant) growth in the bile duct which drain bile from the liver into the small intestine. Other biliary tract cancers include pancreatic cancer, gall bladder cancer, and cancer of the ampulla of Vater. Cholangiocarcinoma is a relatively rare adenocarcinoma, with an annual incidence of 1–2 cases per 100,000 in the Western world, but rates of cholangiocarcinoma have been rising worldwide over the past several decades.

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Causes
Cancerous tumors of the bile ducts are usually slow-growing and do not spread (metastasize) quickly. However, many of these tumors are already advanced by the time they are found.

A cholangiocarcinoma may start anywhere along the bile ducts. These tumors block off the bile ducts.

They affect both men and women. Most patients are older than 65.

Risk Factors:
Although most patients present without any known risk factors evident, a number of risk factors for the development of cholangiocarcinoma have been described; in the Western world, the most common of these is primary sclerosing cholangitis (PSC), an inflammatory disease of the bile ducts which is in turn closely associated with ulcerative colitis (UC). Epidemiologic studies have suggested that the lifetime risk of developing cholangiocarcinoma for a person with PSC is 10%–15%,  although autopsy series have found rates as high as 30% in this population. The mechanism by which PSC increases the risk of cholangiocarcinoma is not well-understood.
Certain parasitic liver diseases may be risk factors as well. Colonization with the liver flukes Opisthorchis viverrini (found in Thailand, Laos, and Malaysia) or Clonorchis sinensis (found in Japan, Korea, and Vietnam) has been associated with the development of cholangiocarcinoma. Patients with chronic liver disease, whether in the form of viral hepatitis (e.g. hepatitis B or C), alcoholic liver disease, or cirrhosis from other causes, are at increased risk of cholangiocarcinoma. HIV infection was also identified in one study as a potential risk factor for cholangiocarcinoma, although it was unclear whether HIV itself or correlated factors (e.g. hepatitis C infection) were responsible for the association.

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Congenital liver abnormalities, such as Caroli’s syndrome or choledochal cysts, have been associated with an approximately 15% lifetime risk of developing cholangiocarcinoma. The rare inherited disorders Lynch syndrome II and biliary papillomatosis are associated with cholangiocarcinoma. The presence of gallstones (cholelithiasis) is not clearly associated with cholangiocarcinoma. However, intrahepatic stones (so-called hepatolithiasis), which are rare in the West but common in parts of Asia, have been strongly associated with cholangiocarcinoma. Exposure to Thorotrast, a form of thorium dioxide which was used as a radiologic contrast medium, has been linked to the development of cholangiocarcinoma as late as 30–40 years after exposure; Thorotrast was banned in the United States in the 1950s due to its carcinogenicity.

Ricks for this condition include:

* Bile duct (choledochal) cysts
* Chronic biliary irritation
* History of infection with the parasitic worm, liver flukes
* Primary sclerosing cholangitis

Cholangiocarcinoma is rare. It occurs in approximately 2 out of 100,000 people.

Symptoms
* Chills
* Clay-colored stools
* Fever
* Itching
* Loss of appetite
* Pain in the upper right abdomen that may radiate to the back
* Weight loss
* Yellowing of the skin (jaundice)

The most common physical indications of cholangiocarcinoma are abnormal liver function tests, jaundice (yellowing of the eyes and skin), which occurs only when bile ducts are blocked by the tumor, abdominal pain (30%–50%), generalized itching (66%), weight loss (30%–50%), fever (up to 20%), or changes in stool or urine color.To some extent, the symptoms depend upon the location of the tumor: Patients with cholangiocarcinoma in the extrahepatic bile ducts (outside the liver) are more likely to have jaundice, while those with tumors of the bile ducts within the liver often have pain without jaundice.
.Yellowing of the skin and eyes (jaundice)->     CLICK & SEE
Blood tests of liver function in patients with cholangiocarcinoma often reveal a so-called “obstructive picture,” with elevated bilirubin, alkaline phosphatase, and gamma glutamyl transferase levels, and relatively normal transaminase levels. Such laboratory findings suggest obstruction of the bile ducts, rather than inflammation or infection of the liver, as the primary cause of the jaundice.  CA19-9 is elevated in most cases

Diagnosis:–
Cholangiocarcinoma is definitively diagnosed from tissue, i.e. it is proven by biopsy or examination of the tissue excised at surgery. It may be suspected in a patient with obstructive jaundice. Considering it as the working-diagnosis may be challenging in patients with primary sclerosing cholangitis (PSC); such patients are at high risk of developing cholangiocarcinoma, but the symptoms may be difficult to distinguish from those of PSC. Furthermore, in patients with PSC, such diagnostic clues as a visible mass on imaging or biliary ductal dilatation may not be evident.

Exams and Tests:-
Blood tests
Blood tests that show abnormal function.
There are no specific blood tests that can diagnose cholangiocarcinoma by themselves. Serum levels of carcinoembryonic antigen (CEA) and CA19-9 are often elevated, but are not sensitive or specific enough to be used as a general screening tool. However, they may be useful in conjunction with imaging methods in supporting a suspected diagnosis of cholangiocarcinoma.
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Abdominal imaging
CT scan showing cholangiocarcinomaUltrasound of the liver and biliary tree is often used as the initial imaging modality in patients with suspected obstructive jaundice. Ultrasound can identify obstruction and ductal dilatation and, in some cases, may be sufficient to diagnose cholangiocarcinoma.  Computed tomography (CT) scanning may also play an important role in the diagnosis of cholangiocarcinoma.

Tests that show a tumor or blockage in the bile duct:
*Abdominal CT scan
*Abdominal ultrasound
*CT scan-directed biopsy
*Cytology
*Endoscopic retrograde cholangiopancreatography (ERCP)
*Percutaneous transhepatic cholangiogram (PTCA)

Liver function tests (especially bilirubin)

Treatment  :-
The goal is to treat the cancer and the blockage it causes. When possible, surgery to remove the tumor is the treatment of choice and may result in a cure. However, often the cancer has already spread by the time it is diagnosed.

Chemotherapy or radiation may be given after surgery to decrease the risk of the cancer returning. However, the benefit of this treatment is not certain.

Endoscopic therapy or surgery can clear blockages in the biliary ducts and relieve jaundice in patients when the tumor cannot be removed.

For patients with cancer that cannot be removed, radiation therapy may be beneficial. Chemotherapy may be added to radiation therapy or used when the tumor has spread. However, this is rarely effective.

Support Groups:-
You can ease the stress of illness by joining a support group with members who share common experiences and problems (see cancer – support group).

Hospice is often a good resource for patients with cholangiocarcinoma that cannot be cured.

Prognosis:

Surgical resection offers the only potential chance of cure in cholangiocarcinoma. For non-resectable cases, the 5-year survival rate is 0% where the disease is inoperable because distal lymph nodes show metastases[63], and less than 5% in general. Overall median duration of survival is less than 6 months in inoperable, untreated, otherwise healthy patients with tumors involving the liver by way of the intrahepatic bile ducts and hepatic portal vein.

For surgical cases, the odds of cure vary depending on the tumor location and whether the tumor can be completely, or only partially, removed. Distal cholangiocarcinomas (those arising from the common bile duct) are generally treated surgically with a Whipple procedure; long-term survival rates range from 15%–25%, although one series reported a five year survival of 54% for patients with no involvement of the lymph nodes. Intrahepatic cholangiocarcinomas (those arising from the bile ducts within the liver) are usually treated with partial hepatectomy. Various series have reported survival estimates after surgery ranging from 22%–66%; the outcome may depend on involvement of lymph nodes and completeness of the surgery. Perihilar cholangiocarcinomas (those occurring near where the bile ducts exit the liver) are least likely to be operable. When surgery is possible, they are generally treated with an aggressive approach often including removal of the gallbladder and potentially part of the liver. In patients with operable perihilar tumors, reported 5-year survival rates range from 20%–50%.

The prognosis may be worse for patients with primary sclerosing cholangitis who develop cholangiocarcinoma, likely because the cancer is not detected until it is advanced. Some evidence suggests that outcomes may be improving with more aggressive surgical approaches and adjuvant therapy.

Possible Complications :-
*Infection
*Liver failure
*Spread (metastasis) of tumor to other organs.

When to Contact a Medical Professional :-
Call your health care provider if you have jaundice or other symptoms of cholangiocarcinoma.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Cholangiocarcinoma
http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/000291.htm

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Abdominal Ultrasound

Alternative Names:- Ultrasound – abdomen; Abdominal sonogram

Definition :-
Abdominal ultrasound is an imaging procedure used to examine the internal organs of the abdomen, including the liver, gallbladder, spleen, pancreas, and kidneys. The blood vessels that lead to some of these organs can also be looked at with ultrasound.

.Click to see the pictures

It uses reflected sound waves to produce a picture of the organs and other structures in the upper abdomen. Occasionally a specialized ultrasound is ordered for a detailed evaluation of a specific organ, such as a kidney ultrasound.

An abdominal ultrasound can evaluate the:
*Abdominal aorta, which is the large blood vessel (artery) that passes down the back of the chest and abdomen. The aorta supplies blood to the lower part of the body and the legs.

*Liver, which is a large dome-shaped organ that lies under the rib cage on the right side of the abdomen. The liver produces bile (a substance that helps digest fat), stores sugars, and breaks down many of the body’s waste products.

*Gallbladder, which is a saclike organ beneath the liver. The gallbladder stores bile. When food is eaten, the gallbladder contracts, sending bile into the intestines to help in digesting food and absorbing fat-soluble vitamins.

*Spleen, which is the soft, round organ that helps fight infection and filters old red blood cells. The spleen is located to the left of the stomach, just behind the lower left ribs.

*Pancreas, which is the gland located in the upper abdomen that produces enzymes that help digest food. The digestive enzymes are then released into the intestines. The pancreas also releases insulin into the bloodstream; insulin helps the body utilize sugars for energy.
*Kidneys, which are the pair of bean-shaped organs located behind the upper abdominal cavity. The kidneys remove wastes from the blood and produce urine.

A pelvic ultrasound evaluates the structures and organs in the lower abdominal area (pelvis).

Why It Is Required to be Done:-
The specific reason for the test will depend on your symptoms. Abdominal ultrasound is mostly  done to:

*Determine the cause of abdominal pain.

*Detect, measure, or monitor an aneurysm in the aorta. An aneurysm may cause a large, pulsing lump in the abdomen.

*Evaluate the size, shape, and position of the liver. An ultrasound may be done to evaluate jaundice and other problems of the liver, including liver masses, cirrhosis, fat deposits in the liver (called fatty liver), or abnormal liver function tests.

*Detect gallstones, inflammation of the gallbladder (cholecystitis), or blocked bile ducts. See an illustration of a gallstone.

*Detect kidney stones.

*Determine the size of an enlarged spleen and look for damage or disease.

*Detect problems with the pancreas, such as pancreatitis or pancreatic cancer.

*Determine the cause of blocked urine flow in a kidney. A kidney ultrasound may also be done to determine the size of the kidneys, detect kidney masses, detect fluid surrounding the kidneys, investigate causes for recurring urinary tract infections, or evaluate the condition of transplanted kidneys.

*Determine whether a mass in any of the abdominal organs (such as the liver) is a solid tumor or a simple fluid-filled cyst.

*Determine the condition of the abdominal organs after an accident or abdominal injury and look for blood in the abdominal cavity. However, computed tomography (CT) scanning is more commonly used for this purpose because it is more precise than abdominal ultrasound.

*Guide the placement of a needle or other instrument during a biopsy.

*Detect fluid buildup in the abdominal cavity (ascites). An ultrasound also may be done to guide the needle during a procedure to remove fluid from the abdominal cavity (paracentesis).
How the Test is Performed :-
This test is done by a doctor who specializes in performing and interpreting imaging tests (radiologist) or by an ultrasound technologist (sonographer) who is supervised by a radiologist. It is done in an ultrasound room in a hospital or doctor’s office.

You will need to remove any jewelry that might interfere with the ultrasound scan. You will need to take off all or most of your clothes, depending on which area is examined (you may be allowed to keep on your underwear if it does not interfere with the test). You will be given a cloth or paper covering to use during the test.

An ultrasound machine creates images that allow various organs in the body to be examined. The machine sends out high-frequency sound waves, which reflect off body structures to create a picture. A computer receives these reflected waves and uses them to create a picture. Unlike with x-rays or CT scans, there is no ionizing radiation exposure with this test.

You will be lying down for the procedure. A clear, water-based conducting gel is applied to the skin over the abdomen. This helps with the transmission of the sound waves. A handheld probe called a transducer is then moved over the abdomen.

You may be asked to change position so that the health care provider can examine different areas. You may also be asked to hold your breath for short periods of time during the examination.

Abdominal ultrasound usually takes 30 to 60 minutes. You may be asked to wait until the radiologist has reviewed the information. The radiologist may want to do additional ultrasound views of some areas of your abdomen.

How To Prepare For the Test:-
Tell your doctor if you have had a barium enema or a series of upper GI (gastrointestinal) tests within the past 2 days. Barium that remains in the intestines can interfere with the ultrasound test.

Preparation for the procedure depends on the nature of the problem and your age. Usually patients are asked to not eat or drink for several hours before the examination. Your health care provider will advise you about specific preparation.

For ultrasound of the liver, gallbladder, spleen, and pancreas, you may be asked to eat a fat-free meal on the evening before the test and then to avoid eating for 8 to 12 hours before the test.

For ultrasound of the kidneys, you may not need any special preparation. You may be asked to drink 4 to 6 glasses of liquid (usually juice or water) about an hour before the test to fill your bladder. You may be asked to avoid eating for 8 to 12 hours before the test to avoid gas buildup in the intestines. This could interfere with the evaluation of the kidneys, which lay behind the stomach and intestines.

For ultrasound of the aorta, you may need to avoid eating for 8 to 12 hours before the test.

How It Feels:-
There is little discomfort. The conducting gel may feel slightly cold and wet when it is applied to your stomach unless it is first warmed to body temperature. You will feel light pressure from the transducer as it passes over your abdomen. The ultrasound usually is not uncomfortable. However, if the test is being done to assess damage from a recent injury, the slight pressure of the transducer may be somewhat painful. You will not hear or feel the sound waves.

Risks Factors:
There is no documented risk. No ionizing radiation exposure is involved.

Results:-
An abdominal ultrasound uses reflected sound waves to produce a picture of the organs and other structures in the abdomen.

Abdominal ultrasound  Normal:
The size and shape of the abdominal organs appear normal. The liver, spleen, and pancreas appear normal in size and texture. No abnormal growths are seen. No fluid is found in the abdomen.

The diameter of the aorta is normal and no aneurysms are seen.

The thickness of the gallbladder wall is normal. The size of the bile ducts between the gallbladder and the small intestine is normal. No gallstones are seen.

The kidneys appear as sharply outlined bean-shaped organs. No kidney stones are seen. No blockage to the system draining the kidneys is present.

Abdominal ultrasound Abnormal:
An organ may appear abnormal because of inflammation, infection, or other diseases. An organ may be smaller than normal because of an old injury or past inflammation. An organ may be pushed out of its normal location because of an abnormal growth pressing against it. An abnormal growth (such as a tumor) may be seen in an organ. Fluid in the abdominal cavity (ascites) may be seen.

The aorta is enlarged, or an aneurysm is seen.

The liver may appear abnormal, which may indicate liver disease (such as cirrhosis or cancer).

The walls of the gallbladder may be thickened, or fluid may be present around the gallbladder, which may indicate inflammation. The bile ducts may be enlarged because of blockage (from a gallstone or an abnormal growth in the pancreas). Gallstones may be seen inside the gallbladder.

The kidneys may be enlarged because of urine that is not draining properly through the ureters. Kidney stones are seen within the kidneys (not all stones can be seen with ultrasound).

An area of infection (abscess) or a fluid-filled cyst may appear as a round, hollow structure inside an organ. The spleen may be ruptured (if an injury to the abdomen has occurred).

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/003777.htm
http://health.yahoo.com/digestive-diagnosis/abdominal-ultrasound/healthwise–hw1430.html

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