Liver and Bile Duct Diseases

Treatments for Bile Duct Disease in Hyderabad, India

Liver Diseases

Humans are equipped with numerous important glands in the body, including the liver. Multiple functions are controlled by the liver, including digestion, storage of energy, hormone regulation, and release of chemicals and nutrients into the body. However, liver diseases can hamper the natural process affecting the quality of one’s life. 

Types of liver diseases

The following liver diseases can broadly be classified:

• Diseases caused by a virus: Hepatitis A, B, C & E

• Other infections: Liver abscess, hepatic tuberculosis

• Fatty liver disease and liver cirrhosis are diseases caused by alcohol abuse

• Liver cancer: Hepatocellular carcinoma and cholangiocarcinoma (bile duct cancer).

• Diseases of the metabolism: jaundice and neonatal jaundice

• A liver disease inherited by the individual: hemochromatosis, Wilson’s disease

Symptoms and signs

It is common for liver diseases to show no symptoms at the beginning. There are however a few obvious and easily noticeable symptoms of liver diseases:

• Swelling and pain in the abdomen.

• Yellow discolouration of the skin and sclera.

• Fatigue

• Loss of appetite

• Itchy skin

• The dark colour of urine and tarry stools

• Weight loss

Diagnosis of Liver diseases

Consult a physician if you experience any liver disease symptoms. The doctor will recommend that you undergo a series of tests to assess your liver function.

Liver function tests:

The liver function test is performed by taking a sample of blood and analysing the liver enzymes, proteins, etc. to assess how the liver is functioning. Common liver function tests include:

Alanine Transaminase (ALT) test: 

Proteins are broken down by the liver enzyme ALT. In cases when abdominal pain, extreme fatigue, jaundice, dark urine or light-coloured stool are observed, an ALT will be ordered. Blood from a patient is gathered by a healthcare provider and sent to a laboratory for analysis. The normal ALT result ranges from 7 to 55 units per litre. ALT levels may be high due to:

• Tumour/s in the liver

• Alcohol abuse

• Death of liver tissue

• Mononucleosis

• Cirrhosis

Aspartate aminotransferase (AST) test: 

AST is also a liver enzyme and is also called serum glutamic-oxaloacetic transaminase (SGOT). The test is recommended if you have symptoms of liver disease. High AST levels indicate that the liver is dysfunctional.

• Gender
• Normal Range
• Males- 10 to 40 units/L
• Females- 9 to 32 units/L

Alkaline phosphatase (ALP) test: 

The liver, bile duct, and bones contain the enzyme ALP. ALP levels should be between 44 and 147 IU/L. In some cases, ALP levels are higher than normal due to liver damage, bile duct obstruction, or bone diseases such as Paget’s disease or rickets. It is possible for ALP levels to be low due to protein deficiency, Wilson’s disease, malnutrition, or hypophosphatemia.

Bilirubin test: 

The liver produces bilirubin, a yellow pigment when red blood cells are broken down. Bilirubin tests are used to determine how much bilirubin is present in the blood. Bilirubin levels in the body cause yellowing of the skin and sclera. Using the lab results you are given the value of conjugated and unconjugated bilirubin, as well as total bilirubin. The normal total bilirubin level for adults is 0.2 - 1.2 milligrams per decilitre (mg/dl). The conjugated bilirubin level should be less than 0.3 mg/dl. The blood bilirubin level can be elevated due to viral hepatitis, cirrhosis, alcoholic liver disease, anaemia, a reaction to blood transfusion, or Gilbert syndrome.

Albumin and total protein test: 

Among the proteins made by the liver are albumin and globulin. In the blood, the normal level of serum albumin is 3.4 to 5.4 grams per decilitre. There are several causes of low albumin levels, including liver damage, malnutrition, nephrotic syndrome, Crohn’s disease, or celiac disease.

Treatments:

Depending on your diagnosis, you will receive different treatments for liver disease. The earlier liver diseases are detected, the lower the chances of liver failure. By adopting healthier lifestyle choices, such as quitting alcohol and maintaining a healthy weight, we can reduce the risk of certain diseases. When not treated on time, this disease may lead to chronic liver failure which could eventually necessitate a liver transplant.

• The chronic form of Hepatitis B can be treated with antiviral medications

• Surgery or radiation therapy can be used to treat benign liver tumours.

• Cancer of the liver can rarely be controlled with drugs that target targeted tissues.

• Patients suffering from severe alcoholic hepatitis can increase their survival rate by taking corticosteroids.

Preventing liver diseases through lifestyle changes

• Nutrition- People with obesity are more susceptible to non-alcoholic fatty liver disease. You may be able to achieve a healthy weight by eating a diet rich in fibre and low in saturated fats. Rather than eating acidic, high-fat foods, you should avoid them to prevent gallstones.

• Limit alcoholic beverages- Excessive drinking can lead to liver cirrhosis.

• Vaccine early- To protect yourself from hepatitis A or B, make sure you receive a hepatitis vaccination as soon as possible.

• Safety measures- Take safety measures when getting piercings or tattoos to avoid infection.

Bile Duct Disease (Noncancerous)

The bile ducts, which assist in digesting fat by carrying bile from the liver to the small intestine, can be blocked by cancer. It is important to note that there are several types of noncancerous bile duct disorders that can also cause problems. Noncancerous bile duct disorders may include the following.

• Cholangitis (infection of the bile duct)

• Infections caused by leaks in the bile duct can occur following certain surgeries

• Biliary stricture (an abnormal narrowing of the bile duct)

• Bilateral stones (choledocholithiasis, the formation of gallstones in the common bile duct)

• Changes in the bile ducts after liver transplantation (such as leaking or narrowing).

It is best to have a team of experts handle the diagnosis and treatment of bile duct disease. Our bile duct specialists have extensive experience treating bile duct disorders using both surgical and advanced endoscopic approaches to relieve obstructed ducts and improve patients’ quality of life.

Bile Duct Disease Symptoms

When the bile ducts cannot function properly, they can cause a variety of symptoms, including:

• Jaundice

• Nausea and vomiting

• Itchy skin

• Pain

Bile Duct Disorders Diagnosis

In order to diagnose blockages and other disorders of the bile ducts, the following diagnostic tests can be performed:

• Imaging tests: CT scans and magnetic resonance imaging (MRI).

• Endoscopic ultrasound (EUS): This procedure utilises a specially designed endoscope and high-powered sound waves to visualize the digestive tract and surrounding organs.

• Probe-based confocal endomicroscopy: The CADC is one of a few centres that offer this highly specialised method of evaluating narrowing in the bile ducts using a small microscope.

• Narrowband imaging: A special system is used in this endoscopic technique to capture images without the use in dyes of the bile ducts. The NBI works on the principle that different wavelengths of light penetrate tissue at different depths. Different wavelengths of light allow doctors to examine the lining of the bile ducts (mucosa).

Treatment for Bile Duct Disorders

Several of our specialists have extensive experience diagnosing and treating bile duct disorders. In order to provide each patient with coordinated, advanced, and individualised care, a multidisciplinary team of specialists in endoscopy, radiology, and surgery works together.

Various surgical techniques, as well as endoscopic procedures, can be used to treat bile duct strictures, obstructions, and leaks. In these cases, endoscopic retrograde cholangiopancreatography (ERCP) is used to insert a stent within the narrowed or blocked area. In ERCP, an endoscope is used along with x-rays for an advanced procedure. In ERCP or EUS-guided ERCP, our interventional endoscopists insert stents to re-open blocked bile ducts, restore function, and alleviate patients’ symptoms.

Bilateral bile duct stones can be removed through ERCP and sphincterotomy (a cut made from the inside of the muscle in the duct). By using a minimally invasive approach, our interventional endoscopists can also remove biliary stones using laser lithotripsy or mechanical lithotripsy.

• Medications:
  • Antibiotics: Used to treat infections in the bile ducts.
  • Ursodeoxycholic Acid: Can dissolve certain types of gallstones and improve bile flow.
• Endoscopic Procedures:
  • ERCP (Endoscopic Retrograde Cholangiopancreatography): Used to remove gallstones or place stents to open narrowed ducts.
  • Endoscopic Balloon Dilation: Inflating a balloon to widen narrowed bile ducts.
• Surgery:
  • Gallbladder Removal: In cases of gallstones causing bile duct obstruction.
  • Bile Duct Reconstruction: Surgical repair of damaged bile ducts.
  • Liver Transplant: Considered in severe cases where the liver is significantly affected by bile duct disorders.
• Percutaneous Transhepatic Cholangiography (PTC): Uses imaging to guide the placement of a drainage catheter to relieve bile duct blockages.
• Photodynamic Therapy: Involves injecting a light-sensitive drug into the bloodstream, which is then activated with light to destroy cancer cells.
• Radiation Therapy: Used to shrink or control the growth of tumors affecting the bile ducts.
• Biliary Stent Placement: Involves inserting a stent to keep the bile duct open and facilitate the flow of bile.
• Lifestyle Modifications:
  • Dietary Changes: Low-fat diets may be recommended to manage symptoms.
  • Alcohol Cessation: Important for those with alcoholic liver disease.
• Management of Complications: Addressing complications such as infections promptly to prevent further damage.
• Follow-up Care: Regular monitoring and follow-up appointments to assess treatment effectiveness and manage any recurrence or new developments.

This comprehensive approach ensures that patients with bile duct disorders receive state-of-the-art, collaborative care that addresses both the structural issues and their associated symptoms.