Hepatobiliary tumors are abnormal growths occurring on or in the liver, bile ducts, and biliary tract, the tubes that carry bile from the liver or gallbladder to the small intestine. The interventional radiologists at ruby hall clinic work closely with gastroenterologists and surgeons to provide a variety of treatment methods for patients experiencing biliary and hepatic diseases.
Treatment options for Biliary Disease include:
1) Percutaneous TranshepaticCholangiograhpy (PTC)
2) Percutaneous Biliary Drains (PBDs)
3) Cholecystostomy
Treatment options for Hepatic Disease include:
1) Percutaneous Liver Biopsies
2) Transjugular Liver Biopsies
3) TIPS (Transjugular Intrahepatic Portocaval Shunt)
4) Variceal Embolizations
Biliary interventions are minimally invasive procedures performed to treat blockages or narrowing and injury of bile ducts. In addition, minimally invasive techniques can be used to treat an inflamed or infected gallbladder. Bile, a fluid that helps digest fat in foods, is produced in the liver and flows through ducts or tubular passageways leading to the gallbladder where it is stored. When needed, the gallbladder contracts and releases bile through ducts into the small intestine.
If the bile ducts become blocked, bile cannot pass into the intestine and this may result in jaundice (in which the level of bile products in the blood becomes elevated).
If jaundice becomes severe, the patient will appear to have a yellowish hue, particularly in the whites of the eye. If the duct that connects
the gallbladder to the rest of the bile ducts becomes blocked (usually due to gallstones in the gallbladder),
Indications for biliary intervention
Cholangitis
Acute cholangitis is a morbid clinical condition that involves acute inflammation and infection of the bile duct. Acute obstructive cholangitis was initially described by Reynolds and Dargan in 1959 as a syndrome consisting of fever, jaundice, abdominal pain, and lethargy or mental confusion, also known as Reynolds’s pentad. Acute obstructive cholangitis may rapidly progress to a serious and fatal infection. Cholangitis occurs when two factors are present: biliary tract obstruction and bacterial contamination of the biliary tract. Without prior intervention, the biliary tree is aseptic, and obstructed patients usually present with jaundice or pruritus. Cholangitis almost always occurs in patients that have been previously instrumented or have had manipulation of the biliary tree from direct or enteric contamination of their biliary system.
As the incidence of malignant disease, sclerosing cholangitis, and non-surgical instrumentation of the biliary tract have been increasing so too has the incidence of cholangitis (6-8). Cholangitis is now commonly seen in the setting of malignancy. When cholangitis occurs in the setting of bile duct isolation, it is critical to identify and drain (if possible) the ducts that were previously colonized to effectively treat cholangitis.
Pruritus
Pruritus is a well-known symptom of biliary obstruction and can be debilitating for patients. Pruritus is usually seen in the setting of jaundice but can occur as the only manifestation of cholestasis and the degree of pruritus can be disproportionate to the serum bilirubin level. Clinically, most patients with cholestatic pruritus present with a diurnal variation of itch intensity, with the worst itch in the late evening and early night-time. Another typical feature of cholestatic pruritus is the tendency to affects the limbs, soles of the feet, and palms although generalized pruritus may occur. Itching is worst with heat, contact with certain fabrics like wool, and psychological stress. Recent studies suggest that increase in serum levels of two mediators: lysophosphatidic acid (LPA-a potent neuronal activator) and autotaxin (an enzyme forming LPA) causes pruritus. Patients with cholestatic pruritus demonstrate significantly higher levels of LPA in their blood compared to patients without pruritus. When the biliary obstruction is the cause of pruritus, drainage of even a small portion of the biliary tree results in a decrease or complete resolution of pruritis.