Hepatobiliary Disease

The hepatobiliary system is made up of the liver, the gallbladder and the ducts or tubes that connect the liver and gallbladder to the small intestine. The liver performs a multitude of functions in our bodies, from detoxifying chemicals, storing other important compounds and producing agents that help us to digest, metabolize and store the nutrients from our food. Like the rest of our body, the liver, gallbladder and the ducts are subject to disease. Diseases of the liver might include problems with storing or metabolizing chemicals, primary cancers of the liver, cancers that have spread to the liver from other sites, cirrhosis due to alcohol abuse, or viral infections known as hepatitis. The liver may also be affected by cystic diseases, parasites and bacterial infections. Many of these diseases require some form of surgical intervention, which may be approached laparoscopically or open depending upon the disease being treated.

The gallbladder is an organ found on the undersurface of the liver. The liver produces bile as one of it’s important functions. The bile is stored and concentrated in the gallbladder, which contracts to empty a portion of it’s contents into the intestine when food reaches the first part of the small bowel. This bile helps in the digestion of this food, especially when high in fat. The most common disease effecting the hepatobiliary system is gallbladder disease. The gallbladder may develop sludge and stones when the chemicals in the bile become imbalanced. The stones may create obstruction and irritation in the gallbladder resulting in the classic symptoms of pain in the upper right abdomen, which is often felt in the back as well, nausea, vomiting and diarrhea, particularly after fatty meals. In some patients, small stones may get out of the gallbladder and become lodged in the common bile duct (the tube that leads from the liver to the bowel). These stones may cause a blockage of bile flow. As this worsens, a patient may become jaundiced (yellow), this condition also has the potential to block drainage from the pancreas, creating pancreatitis, a painful and potentially serious inflammation of the pancreas. Biliary colic (pain) can also be experienced even when no stones are present in the gallbladder. A condition known as biliary dyskinesia, results in a gallbladder which does not eject the bile into the intestine, creating increased pressure in the gallbladder, and therefore the patient experiences right upper abdominal pain and nausea. Tests such as Ultrasound and Hida Scans, as well as blood tests are frequently part of the workup for biliary disease. Gallstones and biliary dyskinesia, are treated very effectively by a cholecystectomy, the removal of the gallbladder. This operation is performed laparoscopically, using three to four small incisions and a video camera. During surgery, dye is injected into the biliary ducts to make sure no stones are present to create obstruction. The operation generally takes 25 to 45 minutes to perform, and the patient goes home the same day. The liver continues to produce bile, which flows into the intestine, where it continues to aid in digestion. Loss of the gallbladder does not limit the body’s ability to digest fatty food, and there are no restrictions to one’s diet after surgery. A small percentage of people will experience diarrhea after cholecystectomy. This generally resolves on it’s own in a few days. If it persists, your surgeon can prescribe a short-term medication which will help it resolve. Laparoscopic cholecystectomy is a very safe and effective treatment for gallbladder disease.

All content copyright 2010, Alan F. Jacks, MD, PA