Page 16 - MedicaWell No3

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16 medica welll

PTC (percutaneous transhepatic cholangiography) or a are used to make the diagnosis.
surgery may rarely be necessary for the treatment of
choledocholithiasis. How is it treated?
The pancreatic pseudocyst and walled-off necrosis are
GALLBLADDER CANCER c) BILE DUCT STONES (CHOLEDOCHOLITHIASIS) PERIPANCREATIC COLLECTIONS SECONDARY TO mostly cured with non-surgical endoscopic cystogas-
What are the symptoms? A stone is identified in the choledochus in one of every PANCREATIC INFLAMMATIONS trostomy. An endoscope is inserted through the mouth
The gallbladder cancer may not cause a symptom or 10 patients with gallstones and the percent rises to and a plastic or metallic stent is placed in the cyst via the
symptoms may point to different diseases. 25%, if the patient is older than 60. Endoscopic Drainage of Pseudocyst and Walled-Off stomach or duodenum and the fluid is drained into the
• Jaundice Necrosis (WON) stomach. In walled-off necrosis, it may be necessary to
• Abdominal pain What are the symptoms? pull the dead (necrotic) tissue of the cyst to the stomach
• Digestive problems Bile duct stones can be clinically asymptomatic or can Pancreatic pseudocyst and walled-off necrosis (WON) with the endoscope. Laparoscopic or open surgery is
• Nausea, vomiting be manifested by complications such as biliary colic are local peripancreatic fluid collections that develop required rarely if the endoscopic treatment fails.
• Food intolerance. (post-prandial abdominal pain and nausea), obstructive following injury of pancreas, including the common
• Weight loss jaundice, inflamed bile duct (cholangitis), liver infection pancreatic canal and/or sub-ducts. The pancreatic canal
• Dark discoloration of urine, white stool (cholangiohepatitis), liver abscesses and pancreatic can be damaged secondary to acute pancreatitis
inflammation (pancreatitis). The biliary colic is frequent- (gallstone, alcohol, trauma, abdominal surgery, ERCP,
How is it diagnosed? ly accompanied by nausea and vomiting. etc.) or chronic pancreatitis (alcohol, autoimmune etc.).
It is highly important to diagnose the gallbladder cancer
at the early stage. Imaging modalities, such as ultra- If the gallstone that obstructs the choledochus is left The early peripancreatic collections gets chronic form
sound, tomography and MRI, are used depending on the untreated, it can lead to cirrhosis of liver. by 5-15% if it superimposes on acute pancreatitis or by
symptoms. As the case many types of cancers, final 40% if it superimposes on chronic pancreatitis; the
diagnosis of the gallbladder cancer is made by biopsy How is it diagnosed? chronic collection is referred to as pancreatic pseudo-
following advanced imaging studies. These methods are Diagnosis of choledocholithiasis is based on physical cyst.
used to diagnose a gallbladder cancer; examination, laboratory, ultrasound and magnetic reso-
nance imaging (MRCP), if necessary. Endoscopic ultra- A pseudocyst is a peripancreatic fluid collection that is
How is it treated? sound (EUS) is rarely necessary for the diagnosis. Physi- enclosed by a fibrous pseudocapsule and does not
Treatment of the gallbladder cancer requires surgical cal examination can be completely unremarkable or contain solid material. Walled-off necrosis (WON) is
removal of the tumor. It may be necessary to remove a minimal tenderness is noted in upper-middle and right necrotic pancreas parenchyma and peripancreatic
part of the liver. If the gallbladder cancer is diagnosed at (epigastrium and right hypochondrium) abdominal quad- tissue that become a collection with internal pancreatic
advanced stage, surgery is no more an option. However, rants or mild yellowness is seen in sclera. The body turns fluid and solid-necrotic tissue which is confined by an
early diagnosis of the cancer ensures successful cure of yellow completely in advanced stage jaundice. inflammatory capsule following necrotizing acute
the gallbladder cancer. For patients with inoperable pancreatitis.
advanced stage disease, possible options include certain How is it treated?
endoscopic procedures that aim elimination of jaundice ERCP: Endoscopic retrograde cholangio-pancreatogra- What are the symptoms?
and alleviation of pain, analgesia and radiological inter- phy is the gold standard in the treatment of choledocho- It can be manifested by abdominal pain, persistent
vention. Heated chemotherapy and recently developed lithiasis. Endoscope is inserted by mouth and the proce- nausea and vomiting, fatigue, weight loss and abdominal
smart drugs may also interfere with the progression of dure lasts 10 to 15 minutes and the success rate is 98%, distension following pancreatic inflammation.
tumor. if the procedure is performed by experienced doctors.
Most patients can start eating meals 2 hours after ERCP How is it diagnosed?
is completed and they are discharged on the same day. Blood tests, ultrasound and CT (computed tomography)