Sometimes, when it comes to problems in the abdominal area, an ultrasound is not clear enough for a diagnosis. In such cases, an Endoscopic Retrograde Cholangiopancreatography (ERCP) may be performed. This procedure gives the doctor a clear view of the duodenum, bile duct, pancreatic ducts, gallbladder and papilla of Vater.

This procedure is usually performed under intravenous sedation without general anesthesia. This procedure involves the use of a duodenoscope, which can be described as a thin, long, flexible tube with a camera at one end. It also has a fiber optic bundle that transmits lights to the camera and a chip to transmit video images to a TV screen.

This is inserted through the patient s mouth and sent down the throat through the food pipe to the stomach and duodenum while the patient is lying on his or her back. The air pipe is left undisturbed so as to not interfere with the patient s breathing. Since the patient is not under general anesthesia, he or she can move and turn according to the doctor s needs. The papilla of Vater is a small nipple like structure with an opening to the bile duct and pancreatic duct. Once this has been identified, a small plastic catheter is passed through the duodenoscope into the bile duct or pancreatic duct through the papilla. Dye is then injected into the area and X-rays are taken of the bile ducts and pancreatic duct. In cases where a biopsy is needed, other instruments can also be passed through the endoscope. Plastic or metal stents can also be passed through this to relieve obstructions in the bile ducts and pancreatic ducts.

ERCP can be used to diagnose and treat a number of conditions in the liver, bile ducts, gall bladder, pancreas and papilla of Vater. These include:

  Blockage of the bile duct by gallstones, cancer, scars, tumors or compression from adjacent organs.

  Jaundice due to an obstructed bile duct. This can also cause light stools and dark urine.

  Persistent upper abdominal pain

  Unexplained weight loss and loss of appetite

  Diagnosing a Dysfunctioning Sphincter of Oddi within the Papilla of Vater

ERCP can also be used to confirm pancreatic cancer and cancer of the bile duct. Once the diagnosis is confirmed, the doctors can customize treatment according to the patient s needs.

Endoscopic Retrograde Cholangiopancreatography - Procedure and Results

Biliary stricture or a bile duct stricture is a condition where the bile duct narrows due to the presence of scar tissues in the body. There are many reasons for scar tissue formation   bile duct surgery, stone in the bile duct or exposure of the abdominal area to radiation. 

This condition can be either malignant or benign. In some cases, the presence of a tumour in the gallbladder can narrow the bile ducts. 

Signs of biliary stricture  

Bile ducts are very small. Because their diameter ranges from 4-10 millimetres, they can easily be blocked by scar tissue. The symptoms are similar to other disorders of the bile duct, where the bile duct is blocked. This stops it from releasing bile into the intestine. 

The symptoms may take a while before they become obvious. In fact, they may take several years as scar tissue takes time to develop.

The common signs are  

Stomach pain, especially on the right side

Fever

Itching

Your skin and eyes turn yellow 

The stools are light coloured

Fatigue

No appetite

Besides this, the biliary stricture can also cause organ inflammation. Liver, gallbladder, and pancreas are the most vulnerable ones in this regard. It can also lead to low blood pressure and sepsis (infection of the blood). 

The link between jaundice and biliary stricture

Because biliary stricture blocks bile ducts, the level of bile in the blood can increase. This may happen because the bile won t follow its normal route   from the liver to the intestine. Hence jaundice might occur.

To treat jaundice resulting from biliary stricture, the first line of treatment involves IV fluids, antibiotics, and antiviral medications. If that doesn t work, then surgery may be necessary to get rid of the bile duct obstructions.

Apart from this, you will also need to adopt certain self-care practices such as alcohol avoidance, proper hydration, and adhering to strict dietary guidelines.



Biliary Stricture & Jaundice - Know The Link!

Jaundice or hyperbilirubinemia is a medical condition that is caused by the high level of bilirubin in the system of a person. It is not a disease in itself but a symptom of various underlying illnesses such as malaria, hepatitis, infection of the liver, destruction of red blood cells or some other causes. It manifests in the form of discoloration of the skin. It turns yellow and so does the white parts of the eyes. The signs and symptoms of jaundice are, yellow skin and whites of the eyes, loss of appetite, weakness, drowsiness, dark colored urine, and fever. Jaundice is diagnosed by physical examination, blood test, or skin test. It can be cured by diet management and allopathic medicines. However, the latter are harsh by nature and if one seeks gentler remedies then Ayurveda is the answer. It has many effective remedies to cure jaundice (pilia) of roots and give quick and lasting relief. 

So, here are some such remedies.

Aloe vera: This Ayurvedic herb is a gentle cleanser that detoxifies the kidneys and liver of the toxins accumulated in the system. It improves the overall digestive functions of the body and is a great tonic for the digestive system. It can be consumed in the form of juice or its pulp can be taken with water.
Bhumyamalaki (Phyllanthus Niruri): A comprehensive liver tonic, bhumyalaki is effective in all kinds of liver disorders. It gives relief in case of all the symptoms of jaundice. Being anti-inflammatory, anti-bacterial, and anti-spasmodic, it cures the liver of infections and also treats the dysfunction.
Yakrit Plihantak Churna: A mixture of beneficial herbs such as kalmegh, katuki, bhringaraj, bhumi amla and others, this churna is a complete medicine for liver disorders. It reduces inflammation and also flushes out the toxins accumulated in the body. It also restores the health of the liver by boosting the regeneration of liver cells.
Changeri (Indian Sorrel): This is helpful in curing symptoms of low appetite and poor digestion. It stimulates digestion and also helps in proper bowel movement.
Chichinda (Snake Gourd): Effective in detoxification and improving the digestive system, chichinda is a rich source of nutrients needed by the human body. It boosts the immune system and also removes worms from the intestines. A natural diuretic, it increases urine secretion, thereby, helping the body get rid of toxins. It can be consumed in the form of juice or taken in mashed form after boiling.
Karela (bitter gourd): A natural cleanser, karela improves the filtration functions of the liver. Being an anti-oxidant, it also restores the immunity of the body, thereby, helping it recover fast.
Ayurveda believes that jaundice or pilia is caused by pitta dosha in the human body and all these remedies work to correct this dosha. Along with these natural remedies, Ayurveda also prescribes plenty of water intake and fluids and abstinence from oily and spicy food as they are known to aggravate the pitta dosha. So, one should follow these instructions and also, take the advice of an Ayurvedic practitioner before taking these remedies.

Jaundice - 6 Ayurvedic Herbs That Can Treat It!

Jaundice is a medical condition where the bilirubin level shoots up in the blood of the affected person. Also referred to as icterus, the condition may affect adults as well as newborn babies (Neonatal Jaundice), whereby the skin and the white part of the eye (sclera) appears yellowish in color (due to the accumulation of bilirubin).

Bilirubin is the bile pigment that results from the breakdown of hemoglobin (when the RBC cells breakdown). The bilirubin thus produced is released into the plasma. The liver then filters the released bilirubin for further metabolism. In the case of a diseased condition, injury or infection to the liver, it fails to remove the bilirubin from the bloodstream. As a result, there is an abnormal rise in the bilirubin level in the blood (Hyperbilirubinemia), resulting in jaundice. In jaundice, Bilirubin can go upto much higher levels. At 2.5-3 it just starts to get manifest as yellow eyes. Obstructive jaundice may require an endoscopic procedure or surgery. 

Types of jaundice:
Jaundice may be of the following types:

Hepatocellular jaundice: In Hepatocellular jaundice, the elevated bilirubin level in the blood is an outcome of a liver disease or an injury (altering the normal functioning of the liver).
Hemolytic jaundice: Here, the increased level of bilirubin in the blood results from an increased breakdown of the RBCs (Hemolysis).
Obstructive jaundice: As the name suggests, Obstructive jaundice results from an obstruction in the bile duct. As a result, the bilirubin does not get filtered and remains in the liver.

Factors contributing to jaundice:
The increased buildup of bilirubin may be an outcome of

Obstruction and inflammation of the bile duct.
Chronic liver disease including liver cirrhosis and hepatitis.
Pancreatic Cancer.
Hemolytic anemia: It is a condition resulting from increased breakdown of RBCs.
Gilbert's syndrome.
Certain medications may also interfere and alter the normal functioning of the liver (steroids, birth control pills, and acetaminophen, to name a few).
In cholestasis, the bile (conjugated bilirubin), instead of getting eliminated, remains in the liver.
Symptoms:
The symptoms associated with jaundice include

The skin (particularly, the face, hands, nails, and feet) and the sclera appear yellowish.
The urine appears dark in color.
Fever, vomiting, tiredness, and loss of body weight.
Abdominal pain (mild to severe).
The stool appears pale in color.
Itchiness or Pruritus.
Diagnosis and treatment:
The earlier the diagnosis, more effective is the treatment.

Jaundice can be diagnosed by
Physical examination.
Bilirubin tests to determine the total bilirubin level.
CBC is used to determine the levels of RBCs, WBCs, and platelets.
Liver function tests.
The treatment for jaundice involves identifying the underlying factor responsible for the condition and treating it.

In the case of obstructive jaundice, operation helps to improve the condition.
Patients with hepatitis may benefit from antiviral medicines as well as steroids.
In hemolytic anemia, use of iron supplements helps to improve the condition.
Avoid oily and spicy foods, smoking and drinking.
Rest as much as possible.

Jaundice - The Right Way It Can Be Treated!

Jaundice is a medical condition, which is characterized by the yellow coloring of the skin and eyes. It generally occurs when there is an excess of bilirubin in your system. Bilirubin is a yellow pigment formed in the liver by the breakdown of red blood cells. It normally gets discharged by the liver along with other dead red blood cells. So if you are suffering from jaundice, it usually indicates that you have some serious problems regarding the functioning of your liver, pancreas, or gallbladder.

Signs and symptoms
Signs and symptoms commonly associated with jaundice include:
1.  Yellow-tinted eyes and skin
2.  The whites of your eyes may turn orange or brown in color
3.  Dark urine
4.  Pale stools
5.  High fatigue and vomiting (in severe cases)

Causes
Jaundice, as mentioned above, occurs when there is an excess of bilirubin and the liver is incapable of metabolizing it along with the old red blood cells. It is more common in infants than in adults, because their livers are not fully developed. However, it is also a frequent occurrence in adults and could be a potential sign of any of the following problems:
1.  Liver infection
2.  Scarring of the liver, or cirrhosis
3.  Hepatitis
4.  Alcohol abuse
5.  Liver cancer
6.  Gallstones
7.  Pancreatic cancer
8.  Blood disorders, like hemolytic anemia
9.  Parasites in the liver
10. Abnormal reactions to or overdose of medication

Diagnosis
Diagnostic tests may include:
1. Jaundice is diagnosed primarily by taking blood tests, to help measure the amount of bilirubin as well as to trace the presence of other diseases like Hepatitis.
2. Liver function tests in order to make comparisons between levels of certain proteins and enzymes when the liver is in good shape and when it is damaged.
3. Liver biopsies, where samples of liver tissue are first extracted and later examined under a microscope.
4. Imaging studies, consisting of abdominal ultrasounds, computed tomography scans and magnetic resonance images (MRI) tests.

Signs, Symptoms and Diagnosis of Jaundice


How To Prevent Jaundice

During monsoons, many people fall prey to Jaundice. Not to be taken lightly, jaundice can prove fatal if strict care is not taken. However there are ways to ensure that we don't fall sick with jaundice. The four main ways in which it spreads are.

1. Enlargement of liver
2. Loss of blood
3. Infection
4. A previous ailment which has left bacteria in the body

SYMPTOMS: Once can have jaundice any time of the year however one needs to be extremely careful during the months of monsoon. The symptoms of jaundice are.
1. Nails and eyes become yellow
2. Skin and urine change colour to yellow
3. Loss of appetite and irritability
4. Loss of taste
5. Nausea and vomiting
6. Tiredness and weakness
7. High temperature with shivering
8. Taste/tongue becomes bitter
9. Vision also becomes yellow
10. Stool changes colour to yellow or black
11. Heavy pulse and headache

DO’s & DON’Ts
Once diagnosed, patients have to be on strict bed rest with regulated medication on diets. They are advised to drink a lot of sugarcane juice, radish juice, glucose water, take ample rest and not do anything strenuous.

Fried and oily foods are strictly prohibited. Ghee, oil, butter or cream should not be consumed. Alongside, vegetables like okra arbi, brinjal and cauliflower should not be consumed. Alcohol, tobacco, tea, coffee and hot & spicy foods are not allowed.

What jaundice patients should eat are light and healthy foods that are easy to digest. Sugarcane juice, tomato juice, lime water, carrot juice, orange juice, and sweet lime juice should be given to the patient. The patient is allowed to drink only boiled water as resistance to infection is very low at this point of time.
 
Moong and masur dals should be included in the diet, along with lots of buttermilk, without any spices in it. It is very important to follow the diet plan as given by the doctor.

If you would like to consult with me privately, please click on 'Consult'.

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Monsoon Time Prevention For Jaundice: DO's & DONT's

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