Hepatobiliary Diseases and Treatment for Liver, Pancreas & Bile Duct

Gallstones are small stones that form in the gallbladder.

Causes of gallstones may include:

• Too much cholesterol in bile
• Too much bilirubin in the bile
• Obesity
• Improper emptying of the gallbladder

In many instances, their presence does not cause any symptoms. If a gallstone becomes trapped inside the gallbladder, a sudden intense abdominal pain known as biliary colic can occur together with nausea or vomiting.

Some people with gallstones may also develop an inflammation of the gallbladder. When gallstones cause symptoms or complications, the condition is known as gallstone disease or cholelithiasis.

Symptoms of a severe gallstone complication include:

• Intense abdominal pain, more on the right upper quadrant
• Jaundice (yellowing of the skin and whites of the eye)
• Fever with chills

The most common liver cancer is hepatocellular carcinoma, which begins in the hepatocyte.

Early stages of liver cancer are generally asymptomatic. As it progresses, the following symptoms may arise:

• Unintended weight loss
• Upper abdominal pain
• Nausea and vomiting

Pancreatic cancer begins in the cells of the pancreas, which is an organ that releases enzymes and hormones to aid digestion and regulate blood sugar.

There are usually no symptoms in the early stages. In the later stages, the patient may develop diabetes with unintended weight loss, jaundice, or pain in the upper abdomen.

Other conditions treated by our hepatologists include:

• Alcoholic liver disease
• Autoimmune hepatitis
• Budd-Chiari syndrome
• Bile duct cancer (Cholangiocarcinoma)
• Drug-induced liver injury
• Metabolic disorders, including hereditary hemochromatosis
• Metabolic Dysfunction-Associated Fatty Liver Disease (MAFLD)
• Viral hepatitis, including hepatitis B and hepatitis C

A computed tomography (CT) scan uses X-rays and a computer to make detailed cross-sectional images of the body.

Magnetic resonance imaging (MRI) uses strong magnetic fields and radio waves to produce high-resolution images inside the body.

Ultrasound imaging uses high-frequency sound waves and a computer to create images of the liver to assess blood flow through various vessels.

Oesophagogastroduodenoscopy (also called OGD or upper endoscopy) uses an endoscope guided into the mouth and throat, then into the oesophagus, stomach, and duodenum, to allow the specialist to evaluate the organs. It also allows the doctor to extract a small tissue sample for biopsy if required.

A liver biopsy enables tissue samples from the liver to be taken, with a needle or during surgery, for examination under a microscope.

Magnetic resonance cholangiopancreatography (MRCP) is a type of MRI scan used to obtain pictures of the bile ducts and internal organs.

Endoscopic retrograde cholangiopancreatography (ERCP) uses an X-ray and an endoscope (a long flexible with a camera at the end) guided through the patient's mouth and throat, then through the oesophagus, stomach, and duodenum.

The specialist can examine the organs from the inside to detect any abnormalities. A tube is then passed through, and a dye is injected to allow the internal organs to appear on an X-ray.

Treatment options for gallstones include:

Surgeries for liver cancer include:

• Surgery to remove the tumour.
• Liver transplant surgery is an option.

Other localised treatment options:

• Radiofrequency ablation uses heat to destroy cancer cells. An ultrasound or CT scan guides your surgeon in inserting one or more thin needles through the abdomen into the tumour, which is then heated with an electric current. This current destroys the cancer cells.
• Cryoablation uses extreme cold to kill cancer. The specialist uses ultrasound images to guide the cryoprobe containing the liquid nitrogen directly onto the tumour and monitor the freezing of the cells.
• Alcohol injections are made directly into the tumour to kill the cancer cells and can be done either through the skin or during an operation.
• Chemoembolization delivers strong anti-cancer drugs directly to the liver.
• Radioembolization uses tiny beads, called microspheres, to deliver radiation directly to the tumour.

Other treatments:

• External beam radiation therapy treatment delivers radiation to the liver while sparing the surrounding healthy tissue.
• Stereotactic radiosurgery involves focusing many beams of radiation simultaneously at one point in your body.
• Targeted drug therapies interfere with specific abnormalities within a tumour and can slow or stop advanced hepatocellular carcinoma from progressing for a few months.

Treatment depends on the stage and location of the cancer, your overall health, and personal preferences. Treatment may include surgery, radiation, chemotherapy or a combination of these.

Operations used to treat pancreatic cancer include:

• Whipple procedure (pancreaticoduodenectomy): Removal of the head of the pancreas
• Distal pancreatectomy: Removal of the body and tail of the pancreas, along with the possible excision of the spleen
• Total pancreatectomy: Removal of the entire pancreas will require lifelong insulin and enzyme replacement

Chemotherapy and radiation therapy are also treatment options before or after surgery.