Anatomy and liver surgery
The liver is a large and important organ; in fact, it is the biggest internal organ in the entire body. It produces bile (digestive fluid), removes toxins from the blood, and helps the body metabolize proteins, carbohydrates, and fats. The liver is what rids your body of toxins such as drugs, alcohol, and other substances, and has an enormous capacity both to heal itself and keep the rest of the body healthy. It goes without saying, then, that liver disease and cancer can cause serious damage to the entire body.
Liver conditions can be caused by a variety of factors. For example, the excessive consumption of alcohol can lead to liver inflammation, jaundice, and cirrhosis (scarring). However, even people who do not drink can develop non-alcoholic liver disease (NALD), a term that refers to a wide range of liver diseases that occur in people who do not consume excessive amounts of alcohol. This category includes non-alcoholic steatohepatitis (NASH) and cirrhosis.
- Non-alchoholic Steatohepatitis
- Liver Cancer
Non-alcoholic steatohepatitis is a liver disease that involves the accumulation of fat in the liver along with inflammation and damage. NASH is commonly referred to as a “silent” disease, since it shows few or no symptoms until it has reached more advanced stages. Symptoms are generally non-specific and include fatigue, weight loss, and overall malaise.
The liver has an amazing capacity to heal itself after being exposed to a number of toxins every day. With cirrhosis, the healing process becomes somewhat skewed, and instead of forming new, healthy tissue, the liver produces an excessive amount of large cells that lead to chronic scarring. This scarring inhibits the liver’s ability to function properly. In its advanced stages, cirrhosis can cause symptoms such as weight loss, jaundice, chronic itching, fluid retention, and mental confusion.
Cancer can either originate in the liver or metastasize from other areas of the body. Like non-alcoholic fatty liver disease, liver cancer doesn’t generally exhibit specific symptoms until it has reached an advanced stage. When symptoms do appear, they can include fatigue, weight and appetite loss, an enlarged liver, a swollen and painful abdomen, and jaundice (yellow discoloration of the skin and eyes). Although liver cancer can be a difficult condition to treat, surgery can prevent a tumor from spreading or eliminate it entirely, depending on how early the cancer is caught.
The pancreas is a 6-inch gland located between your spine and your stomach, surrounded by the intestine and liver. Hormones are produced by the pancreas including insulin. The hormones help the body use food energy. The pancreas also produces enzymes the help digest food and are released through a bile duct into the small intestine.
Symptoms and Conditions
Symptoms that may indicate a problem with the pancreas include:
- persistent abdominal pain in the upper left or upper middle abdomen
- pain that is worse when lying flat on the back
- pain that is worse within minutes after eating or drinking
- nausea or vomiting
Disorders of the pancreas are usually caused by a tumor resulting from pancreatic cancer, or inflammation from chronic pancreatitis. Pancreatitis can also be caused by gallstones, pebble-like deposits that form inside the gallbladder and can block the pancreatic duct as they pass through the intestine.
While many people who have chronic pancreatitis recover from the inflammation, in others it can destroy pancreatic tissue causing part of the pancreas to die. Patients who abuse alcohol or smoke often can experience pancreatitis. In other patients the condition occurs without reason, developing over many years.
The gallbladder is a small, pear-shaped organ in the abdomen that produces, stores, and releases bile, a fluid produced by the liver that helps digest fats in the small intestine. If the bile in your gallbladder becomes chemically imbalanced, it can form into hardened particles that grow over time and eventually turn into gallstones.
When your gallbladder is not working correctly (biliary dyskinesia), these symptoms may occur:
- Pain after eating in the middle or right upper belly
Gallstones can be quite painful and, if left untreated, can lead to serious complications. For example, if the stones move to nearby bile ducts, they can cause blockages that lead to jaundice (the build up of bile chemicals in the blood), or inflammation of the pancreas (pancreatitis).
Once gallstones have been identified, either through a CT or CAT scan, hepatobiliary (HIDA) scan, or other test, surgical removal of the gallbladder is usually the best option.
Patients with gallstones are also more likely to develop gallbladder cancer due to the increased exposure of gallbladder cells to toxins. However, this complication is very rare, and most gallstone patients never develop gallbladder cancer.
Hepatopancreatobiliary surgery consists of the diagnosis and surgical treatment of benign and malignant diseases of the liver, pancreas, gallbladder, and bile ducts. Surgeons trained in hepatopancreaticobiliary (HPB) operations have treated many patients with diseases of these organs, and can offer a wide variety of treatment options
Types of Diseases
Liver Tumors – Tumors of the liver can be either primary liver tumors or liver metastases from other sites in the body. Primary liver tumors develop from cells of the liver and may require removal of multiple segments of the liver. The most common tumor to metastasize to the liver is colorectal cancer. Another type of tumor that metastasizes to the liver is a neuroendocrine tumor of the gastrointestinal tract. Removal of these metastatic tumors to the liver can extend survival for patients with cancer.
Pancreas Tumors – Cancers of the pancreatic duct are the most common but patients can develop neuroendocrine tumors of the pancreas as well as cystic tumors that can either be precancerous or malignant upon presentation. Tumors of the pancreas require special operations for complete removal, and the specific operation undertaken is determined by the location of the tumor. Tumors involving the head of the pancreas may require an operation called pancreaticoduodenectomy for complete surgical resection; this operation is also called the Whipple operation after a surgeon in the 1930’s who first successfully completed it.
Gallbladder and Bile Duct Tumors – These types of cancers are relatively rare. However, when identified, extensive surgery is required to achieve complete removal. Gallbladder cancer is surgically treated with complete removal of gallbladder and surrounding tissues, excision of a portion of liver, and clearance of lymph node tissue around the bile duct. Removal of segments of the bile duct is necessary for bile duct cancer, also called cholangiocarcinoma.