Liver, pancreas and bile duct diseases

When handling patients suffering from diseases of the liver, pancreas, and bile duct — commonly known as hepatobiliary diseases—utmost expertise is of critical importance given the sensitivity of the organs.

Dr Karan Gandhi, a consultant general and laparoscopic surgeon at Aga Khan University Hospital is also Kenya’s only hepatobiliary surgeon and shades light on these life-threatening diseases and how he treats them.

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What does hepatobiliary surgery sub-speciality entail?

This is surgery of the liver, pancreas, and bile duct. It is a highly specialised field.

What symptoms can I look out for?

Hepatobiliary diseases can be classified as either benign or malignant (cancerous). The most common disease is gallstone disease. Symptoms for this can range from asymptomatic to mild abdominal pain (mostly in the right upper abdomen), acute infections of the gallbladder (which may vary in severity) and jaundice when a stone slips out of the gallbladder and blocks the duct that drains to the intestines.

Gallstones can also lead to pancreatitis which is characterised by severe pain in the upper to the mid-abdomen, typically radiating to the back.

Jaundice (yellow eyes and skin) is a very common symptom for a variety of these diseases and, apart from gallstones, can be caused by a wide array of diseases including viral infections of the liver (Hepatitis B and C), duct strictures, autoimmune diseases and malignancies (cancer).

Other infectious diseases of the liver include liver abscess (pus collection from bacterial or amoebic infection) and parasite infections like worms or hydatid disease. When it comes to cancers, it can of the pancreas, bile ducts (cholangiocarcinoma), gallbladder, or the liver.

Furthermore, liver cancers may arise primarily from the liver or maybe secondary cancers that spread from cancers of other organs (most commonly the colon/rectum, but also stomach, breast, pancreas, etc).

Unfortunately, apart from jaundice, there are no specific symptoms of hepatobiliary cancers and they may be vague. Inevitably, this means that a lot of them are picked up or diagnosed late.

Are there risk factors that can expose me to hepatobiliary diseases?

Alcohol is responsible for pancreatitis, liver cirrhosis, and liver cancer.

Viral infections of the liver (Hepatitis B and C), certain parasitic infections, and metabolic diseases.

Metabolic diseases include diabetes and high cholesterol, which can lead to fatty liver disease, gallstones, and also pancreatitis.

Family history: Certain diseases may run in families such as cancers or autoimmune diseases.

Exposure to aflatoxin: This is one striking risk factor, especially in rural areas. This is a toxin that accumulates in grains stored in warm and humid places.

What treatment options are available locally? Must I undergo surgery?

Not all diseases need surgery. Treatment can be divided into medical, endoscopic, surgical, and radiological.

Short of transplant, other treatments for these diseases are available locally and at Aga Khan University Hospital.

Seek the opinion of a specialist instead of self-diagnosing using the internet as some resources can be misleading. Medical treatment may include antibiotics, anti-viral treatment, pain killers and other more specific therapies including chemotherapy for cancers.

Surgical treatment may be either laparoscopic (keyhole) or open surgery, via larger incisions.

Endoscopic treatment involves the use of cameras inserted via the mouth, to diagnose or find and treat a problem.

Radiological therapy involves the use of image guidance to reach and treat a potential problem or to obtain biopsy specimens via a skin puncture with a needle.

For gallstones disease, the only real way to treat it is by removal of the gallbladder. Despite alternative therapies being studied, none have shown many benefits. The surgery for gallbladder removal is done laparoscopically and patients usually go home the following day. Currently, most liver and pancreatic surgery are performed via the open approach.

Are there lifestyle changes that can help reduce the risk of getting hepatobiliary diseases?

—Living a healthy lifestyle is key in the prevention of hepatobiliary disease.

—Reduce alcohol intake significantly. Evidence may suggests that one drink a day is beneficial, but in all honesty, how many of us have the self-control to limit that to one and only one?

—Engage in regular exercises and diet control, to maintain a healthy weight and cholesterol levels.

—Get vaccinated against Hepatitis B and C viruses. Hepatitis B is one of the leading causes of liver cancer.

—Unfortunately, there are no well-established screening programmes for hepatobiliary cancers, except in certain high-risk groups— for example, cirrhosis leading to liver cancer.

Dr Gandhi is a consultant general and laparoscopic surgeon at Aga Khan University Hospital Nairobi