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Treatment of Liver Disease
Liver Problems Treatment
Treatment of Liver Cancer
Liver Replacement Treatment
Treatment of Pancreatic Fistula
Treatment of Pancreatic Cancer
Treatment of Gallbladder Cancer
Treatment of Gallbladder Disease
Treatment of Biliary Cirrhosis
Gallbladder Cancer Surgery
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Dr. Ankur Garg provides answers that are very helpful. It is very useful advise sir.
Dr. Ankur Garg provides answers that are very helpful. Yes helpful
Liver transplantation or hepatic transplantation is the second most carried out transplant procedure in the world. It is a potentially difficult surgery that is performed by a team of two to four surgeons along with the help of anesthesiologists and nurses. It takes around 10 to 12 hours to complete the procedure as there are many anastomoses, sutures, reconnections, and disconnections, which are to be performed under the liver bed which is necessary for the transplant to be a success.
Tests required before a transplant is planned
1. Computed tomography, or CT scan which employs X-rays and a computer to create pictures of the liver, showing its size and shape. CTs and chest X-rays are also recorded to evaluate your heart and lungs.
2. Laser Doppler flowmetry: to check if the blood vessels to and from the liver are normal.
3. Echocardiogram to check the status of heart function.
4. Pulmonary function test or lung capacity test to study and determine the lungs' ability to exchange oxygen and carbon dioxide.
5. Blood tests are performed to determine the patient's blood type, clotting ability, and biochemical status of blood, and to determine liver function.
The liver transplant procedure
- After an admission at the hospital, an Intravenous line is started in the patient's arm or hand. Other tubes (catheters) are put in their neck and wrist, or their collarbone or the area between the belly and the thigh (the groin). These are used to check heart and blood pressure, and to get blood samples.
- The patient is placed on the back, over the operating table.
- If there is too much hair at the surgical site, it may be shaved.
- A catheter is placed into the bladder to drain urine.
- After the patient is sedated, the anesthesiologist will insert a tube into the lungs. This is done so that the breathing can be helped with a ventilator. The anesthesiologist will keep checking the heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
- The skin at the surgical site will be cleaned with a sterile (antiseptic) solution.
- The doctor will make a cut (incision) just under the ribs on both sides of the belly.
- The doctor will carefully separate the diseased or the injured liver from the nearby organs and structures.
- The attached arteries and veins are then clamped to stop the blood flow into the diseased liver.
- The diseased liver will be cut off from the blood vessels and then removed.
- The surgeon will check the donor liver before implanting it into the body.
- The donor's liver is placed in the patient's body.
- The incision will then be closed with sutures or surgical staples.
Living donor liver transplant is the procedure where a portion of the liver of a living donor is transplanted to one whose liver is damaged and beyond recovery. The source of graft liver can be from two sources namely from a deceased brain-dead donor or a Living-related donor and termed respectively as DDLT ( Deceased donor liver transplant) and LDLT ( Living Donor Liver Transplant) .
In case of DDLT , the recipient name is registered in the NOTTO list , and whenever a suitable brain-dead donor is available the recipients are transplanted according to their position on NOTTO list. DDLT involves a longer waiting time before a deceased donor may become available which can be anywhere between a month to years . The recipient runs a risk of developing a fatal complications during the waiting period. In LDLT ( Living donor liver transplant) the graft liver is procured from a living donor who is related to recipient and agrees to donate a portion of his liver. After careful pre-operative evaluation of prospective donor nearly 60-70% of liver of donor is removed and transplanted into the recipient.
Due to the unique ability of human liver to regrow, within 6-12 weeks nearly 100% of previous liver volume is achieved. LDLT enjoys the benefits of a elective surgery done without any waiting time and delay. However both DDLT and LDLT have nearly 90% success rate and both the procedures have their own benefits and lacunaes. Also the decision to go for DDLT and LDLT may vary for any particular patient.
Factor that makes living donors potent enough to donate part of their liver:
- As the liver is composed of two lobes , right and left lobe. Also the liver has an unique ability to regenerate.
- The donor’s right lobe preferably transplanted in and adult recipient and left lobe is transplanted in pediatric age group .. When the portion of the liver is in place in the recipient’s abdominal cavity, the transplanted liver generates supplementary liver tissue adequate for decent functioning.
- The donor liver regrows to nearly 90% of its original volume in 6 weeks and nearly 100 % in three months. Morever liver functions tests revert to completely normal even before complete regeneration happens.
The knowledge, essential for the living liver donors:
- The living donor transplant method is a lifesaver, but there are some concerns. The donor should have an excellent health record and should be free from cancer, pulmonary hypertension, congestive heart failure, or any other chronic diseases.
- The donor’s liver must be healthy and large enough so that it works correctly after the right lobe is removed. The operation may take many hours, and both the recipient and the donor must rest in the ICU overnight.
- The donor can be discharged by the end of one week and can resume normal household and office work by end of second week.
Patient is advised to avoid abdominal straining for three months but after that he or she can resume absolutely normal life style. Living donor liver transplants have an advantage that they can be performed in elective setting when the patient and donor are well-optimized, eliminates the waiting time, donor liver has been well evaluated and can be performed quickly in advanced or decompensated patients. In case you have a concern or query you can always consult an expert & get answers to your questions!
I have hepatomegaly with grade 2-3 fatty change. Liver enlarged 176 mm. It is dangerous? What is the treatment? Please tell me.
Complications! This one word can bring in all the feelings of insecurity, anxiety, and restlessness. If you are having a liver transplant surgery, a very common question that keeps on disturbing you is the surgery complications that might arise. Some of the problems specific to liver transplantation that may be encountered include Primary non-function, or reduced function of the newly transplanted liver occurs in approximately 1-5% of new transplants. If the role of the liver does not improve sufficiently or quickly enough, the patient may urgently require a second transplant to survive.
The following are the Liver Transplant Surgery Complications:
- Hepatic artery thrombosis or clotting of the hepatic artery: Hepatic artery is the blood vessel that brings oxygenated blood from the heart to the liver. This kind of thrombosis occurs in 2-5% of all deceased donor transplants. The liver cells (hepatocytes) themselves usually do not receive blood supply from the hepatic artery. The liver cells (hepatocytes) are nourished by blood by the portal blood flow. The bile ducts, in contrast, depend strongly on the hepatic artery for nutrition. So, loss of the hepatic artery flow ( HAT) may lead to bile duct complications.
- Biliary complications: In general, there are two types of biliary problems: leak or stricture. Biliary complications affect nearly 15% of all deceased donor transplants and up to 40% of all live donor transplants. A biliary leak is a condition where bile is leaking out of the bile duct and into the abdominal cavity. Most commonly, this occurs where the donor and recipient bile ducts were sewn together. This is often handled by placing a stent across the connection through the stomach and small intestine and then providing the connection to heal. Bile can also leak from the cut edge of the liver in the case of living donor or split liver transplants. Typically, along the cut edge drain is placed and left during the transplant operation to eliminate any bile that may leak. Sometimes the bile tends to collect in the abdomen and complications can arise.
- Bleeding: A little bleeding after a liver transplantation is normal because of the widespread nature of the surgery and due to liver failure the coagulation factors are critically depleted. Most transplant patients bleed a minor amount and may get additional transfusions after the operation. It is best to consult a doctor if bleeding is substantial.
- Infection: It is important to take precautions as wound created by any operation can be often lead to infection. Liver transplant receivers are also at danger for infections deep within the abdomen, especially if there is an accumulation of blood or bile from a bile leak.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Liver transplant in the only curative option available for patient who develop cirrhosis of liver due to any cause ( Chronic Hepatitis B , Chronic Hepatitis C, Alcoholic Cirrhosis, NASH etc). Once patient has been diagnosed with cirrhosis it can not be reversed with any non-surgical treatment . Over a period of time patient may develop worsening in liver function resulting in complications of cirrhosis (bloody vomitus, black stools, jaundice , altered sensorium, renal dysfunction, abdominal swelling etc) labeled as “decompensated cirrhosis”. These patients require Liver transplant at the earliest and should be reffered to a liver transplant centre immediately. Ideally all patient diagnosed with cirrhosis should be under the follow-up of a gastroenterologist/Hepatologist. The source of graft liver can be from two sources namely from a deceased brain-dead donor or a Living-related donor and termed respectively as DDLT ( Deceased donor liver transplant) and LDLT ( Living Donor Liver Transplant) . However both DDLT and LDLT have nearly 90% success rate and both the procedures have their own benefits and lacunaes. Also the decision to go for DDLT and LDLT may vary for any particular patient.
Before the Liver transplant
All recipient and Living donor go thorough evaluation before the transplant process that includes blood investigations, Imaging studies, Cardiac and pulmonary fitness tests, multidisciplinary consultation before the clearance for liver transplant is achieved. The healthcare provider will explain the entire procedure. The healthcare provider is also supposed to answer all your questions. You would be needed to sign a consent form that allows the doctor to do the surgery. Eating food is not allowed at least 8 hours before the surgery. If you cannot stay relaxed before the surgery, a sedative will be given.
After the Liver Tranplsant
The recipient surgery lasts for anywhere between 12-16 hrs and donor surgery for 8-12 hrs. After the surgical procedure is complete, you will be taken to the intensive care unit (ICU)and will be closely watched for several days.
Immediately After the Surgery
You will most likely have a tube in your throat. This is so that you can breathe with the help of a machine (a ventilator) until you can breathe on your own. The ventilator tube will be removed on next morning when all parameters are found to be satisfactory. All parameters are monitored by round the clock critical care doctors and staff for a few days. The recipient has to stay in the hospital for three weeks and the donor is discharged in one week.
Blood samples will be collected on a regular basis to check the functioning of the new liver. Antibiotics will be infused via IV channels to prevent you from infections. The area where the operation was done should always be kept clean after you have reached home. Any stitches or surgical sutures will be removed at a follow-up visit.
Complications that may arise
Blocked blood vessels to the new liver, bleeding, an infection, leakage of bile or blocked bile ducts, or the new liver not working for a short time right after surgery are a few complications that may arise. Not to aggravate the condition, in the case of a complication, it is imperative to visit your doctor. In case you have a concern or query you can always consult an expert & get answers to your questions!
Did you know that liver stands second among the most transplanted organs in the human body? Liver diseases are becoming more prevalent today. A liver transplant becomes necessary when a person’s liver is diseased or injured. Through surgical procedures, a part or the complete healthy liver is transplanted from the donor.
Here are some of the typical reasons for a liver transplant:
- Autoimmune Hepatitis: In this kind of hepatitis, the body's immune system is not able to recognize its own liver tissue. It thus begins to injure the liver cells and that finally leads to scarring, liver cirrhosis, and end-stage liver disease. Unlike chronic viral hepatitis, this disease is not caused by a virus.
- Chronic viral hepatitis B, C, D: Hepatitis is caused by the viral infection which results in swelling, inflammation, and cell damage. All these lead to liver destruction or scarring. The different types of hepatitis are A, B, C, D and E. Hepatitis B is the leading indicator of liver cancer worldwide.
- Non alcoholic fatty liver disease: Fat accumulation in the liver cells causes this disease. It is said that excessive alcohol is the leading cause of a fatty liver. But this condition is also seen in patients with diabetes and obesity. This condition can cause liver cirrhosis.
- Primary sclerosing cholangitis: In this disease, the bile duct becomes progressively damaged by inflammation. This results in scarring that narrows the bile duct and causes obstruction to the flow of bile.
- Biliary cirrhosis: Sometimes there is a blockage in the bile duct. The liver creates bile which passes from the bile duct to the gallbladder. From here it is slowly released into the small intestine and helps in digesting fats. When the bile duct is blocked, all the bile that is produced accumulates in the liver and causes swelling and eventually loss of liver function.
- Active liver failure or toxic exposures: People suffering from acute liver failure caused by other reasons such as viral infection, fatty liver, etc. can undergo liver transplant surgery. Exposure to certain pesticides, herbicides, lead, asbestos and other hazardous pollutants can be the cause of a potentially life-threatening liver disease.
- Caroli's disease and choledochal cyst: The bile ducts become dilated and result in the formation of cysts or sacks. This causes infection and obstruction of the bile ducts. Choledochal Cyst, On the other hand, is a congenital disorder. A choledochal cyst is formed due to a structurally flawed bile duct. In both these scenarios getting a transplant is mandatory.
- Hepatic tumors: Tumors that spread either from other parts of the body or those that develop in the liver itself can cause severe damage to this organ.
It is best to consult an expert to know if a liver transplant is necessary for you. Hence, when you have problems related to liver seek medical advice without delay.
Liver, being the largest gland present inside the body, weighs almost 3 pounds. It is a vital organ of the human body and performs critical functions which are required for the normal functioning of the body. The liver makes protein which is required for blood clotting. The liver also produces many other enzymes which are required in cellular pathways.
In many cases, due to chronic or acute illnesses, a portion of the liver gets injured or damaged. In these cases, liver transplantation or hepatic transplantation under immunosuppressive drugs is a potentially successful treatment which can be performed by surgeons under ideal conditions.
When is a liver transplant necessary?
Liver transplant is a procedure to replace a diseased or necrosed liver with either a whole or a part of a healthy liver from a donor. This may come from a living or deceased donor. The surgery is extremely complicated with an average duration of 10-12 hrs. Before transplantation, liver support therapy might be indicated. A liver transplant is always the last option, for any liver-damaging conditions including alcohol abuse, hepatitis, and cancer.
Any condition leading to acute liver failure requires a liver transplant, provided that the recipient does not have other conditions that will fail a successful transplant.
Other potential causes leading to a liver transplant
A patient is advised for a liver transplant procedure when the liver is damaged to a condition where a cure is not possible. The many potential reasons that would need a person to undergo liver transplant are:
Viral hepatitis which includes all types of hepatitis (A, B, C, D, E) which are blood Bourne or transmitted through oral or fractal route.
- Acute and subacute necrosis of liver
- Alcoholic fatty liver
- Alcoholic cirrhosis of liver
- Chronic hepatitis
- Cirrhosis of liver without mention of alcohol
- Biliary cirrhosis
- Cystic fibrosis
- Benign neoplasm of liver and biliary passages
- Neoplasm of unspecified nature in digestive system
- Pure hypercholesterolemia
- Carcinoma of liver and biliary system
- Neoplasm of uncertain behavior in liver
- Disorders of bilirubin excretion
- Disorders of copper metabolism
- Congenital factor VIII disorder
- Congenital factor IX disorder
- Budd-Chiari syndrome
- Other chronic nonalcoholic liver disease
- Unspecified liver disease without mention of alcohol
- Other sequelae of chronic liver disease
- Other specified disorders of gallbladder
- Cholangitis, obstruction of bile duct
- Biliary atresia
- Perinatal jaundice due to hepatocellular damage
- Other specified perinatal disorders of digestive system
- Injury to liver
- Disorders of purine and pyrimidine metabolism
- Encephalopathy, unspecified
- Portal vein thrombosis
- Deficiencies of circulating enzymes
A liver transplant is suggested if other traditional treatments for liver disease aren’t enough to keep a person alive. Though waiting for a liver transplant is a long process, the surgery coordination happens quickly once you have a match. If you wish to discuss about any specific problem, you can ask a free question.