Care and Cure of Hepato-Pancreto-Biliary diseases

How to diagnose HPB disease (symptoms):

• Yellowness of eyes
• Pale stools
• Dark urine
• Itching all over the body
• Swelling of the abdomen, ankles and feet
• Excessive fatigue
• Bruising and easy bleeding
• Bleeding with vomiting or dark tar like stools
• Confusion and excessive sleepiness

How to diagnose HPB disease (tests):

• Liver function tests (LFTs) are blood tests that determine the functional level of the liver.
  
• Amylase / Lipase are blood tests, when raised, indicate inflammation or swelling of the pancreas.
• Tumor markers are blood tests that are elevated in presence of certain tumors i.e. AFP(alpha feto protein) may be raised in liver tumors, CA 19.9 may be raised in bile duct tumors, CEA (carcino-embryonic antigen) is raised in tumors of large intestine and rectum spread to the liver.
• X ray of the abdomen and chest are frequently used to diagnose HPB diseases and also to determine their spread
• USG (Ultrasonography / Ultrasound) is a simple, readily available test that can diagnose most liver diseases. It can differentiate a normal liver from fatty and cirrhotic (severely damaged) liver. USG with doppler examination can also be used to study the blood vessels of the liver. Newer techniques of doing USG with contrast are more accurate in differentiation of various mass lesions of the liver. USG is commonly used for guidance during targeted therapies for liver tumors.
• CT scan of the abdomen is the most commonly used radiological test to study diseases of the liver and pancreas. CT scan done with contrast can delineate all blood vessels of the liver and pancreas. It can determine whether the liver is cirrhotic, and also differentiate between various tumors of the liver accurately. It is also indispensible in planning surgical and radiological approach for treatment of liver diseases. CT scan is the most important tool for diagnosis of pancreatic diseases and for planning treatment.
• MRI is a very valuable tool in diagnosis of HPB diseases. It can identify smaller tumors better than most other tests and is especially valuable in patients with kidney problems. MRCP is a type of MRI where the bile ducts are very well visualized and is commonly used for locating bile duct tumors and identifying post-operative complications.
• Biopsy is a test where a small bit of tissue is removed by inserting a needle, commonly under guidance of USG, which is then studied under a microscope. The biopsy may be done from the liver, pancreas or from a tumor. Fine needle aspiration (FNA) is a type of liver biopsy where a very thin needle is used for biopsy, is less painful, but also gives fewer number of cells. Biopsy is the most reliable way to diagnose tumors, however, it is not without its risks. It carries a risk of bleeding, especially, if inadvertently a hemangioma (tumor of the blood vessels) is biopsied. However, a biopsy is rarely done for liver tumors because of risk of spreading the tumor outside the liver.
• Endoscopy is a test where the lumen of the intestines can be seen with a camera. Upper GI endoscopy is used to see oesophagus, stomach and duodenum. Colonoscopy is used to see the large intestine and rectum. ERCP is used to see the bile duct through the duodenum, by putting dye into the bile duct and doing an x-ray. Endoscopy can also be used to take biopsies and put stents. EUS (endoscopic ultrasound) can be used to diagnose small tumors in pancreas and do a guided FNA.

Preventive strategies for liver, biliary and pancreatic diseases:

What one needs to do to have a healthy liver/pancreas, avoid gall stone disease (avoiding fatty foods / alcohol) different ailments and their preventive measures:

• Avoid fatty food, because fatty food increases the cholesterol level in the body, which may lead to formation of cholesterol stones in the gall bladder or fatty liver.
• Avoid alcohol, because alcohol can cause damage to one’s liver by causing fatty liver or even cirrhosis. It can also cause serious damage to the pancreas as pancreatitis.
• Avoid street food, or unhealthy food, which can potentially transmit hepatitis A or E infection, leading to acute liver failure
• Avoid untested blood transfusion or unsafe sexual practices, which can transmit hepatitis B or C infection, which can cause chronic liver disease.
• Some liver tumors such as hemangioma or adenoma can increase in size during pregnancy or oral contraceptive use and therefore should be looked for on an USG examination.

Some myths and truths about common HPB ailments

Jaundice can be treated by magic / drinking neem juice
No. Most commonly jaundice is caused by hepatitis A or E infection. Both these forms of hepatitis are self-limiting and resolves over 3-4 weeks, with or without any treatment. However, most people with jaundice are not tested for these viral infections and therefore attribute its resolution to any form of treatment they may have received during this period.

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