Multaq Warning : If your doctor notes elevated levels of AP and GGTP enzymes in your blood, he or she will likely order an endoscopic retrograde cholangiopancreatogram. During a ERCP, patients are sedated, and a small lighted tube (called an endoscope) is inserted into the mouth and threaded through the small intestine until it reaches a tiny intestinal opening called the ampulla ofVater, which leads to the extrahepatic bile ducts. A thinner tube is inserted into the ducts, creating access for a contrast dye that highlights the ducts on an X-ray, enabling doctors to see them and determine if they are damaged.
If the bile ducts are narrowed and irregular, a diagnosis of PSC is confirmed. In some cases, narrowed bile ducts can be dilated or a stent (a small tube) can be inserted to keep a duct open. After these procedures, patients feel much better because bile flows more freely. Nonetheless, new narrowings can still develop.
Occasionally, if an ERCP is not available or cannot be performed, magnetic resonance cholangiopancreatography (MRCP) may be employed instead. An MRCP is an MRI that looks at the biliary tree. But the MRCP does not allow for dilation or stenting; it simply produces a diagnostic picture.
Primary sclerosing cholangitis does not follow a predictable course. Symptoms may persist at the same level, occur intermittently, or steadily progress. In some patients, 15 to 20 years may elapse before the liver deteriorates ro the point of failure and a transplant must be considered.
Because the disease progresses slowly, a biopsy will show the extent of damage to the liver, but a biopsy is rarely used to make the initial diagnosis. Primary sclerosing cholangitis follows a staging system that gives insight into the patient’s longer-term prognosis, with stage 1 indicating early scarring and narrowing of the bile ducts, and stage 4 carrying a diagnosis of cirrhosis.
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Primary sclerosing cholangitis is an incurable disease, but its symptoms can be treated and its progression slowed. To resolve itching, patients should sample the range of available medications, including prescription medications such as cholestyramine (Questran), which binds bile salts in the intestine and allows them to be eliminated with stool, thereby reducing their accumulation in the liver and skin.
More serious complications of primary sclerosing cholangitis are osteoporosis and osteomalacia (bone-calcium deficiency). Patients are advised to increase their intake of calcium with vitamin D to boost absorption and to consider bone-density medications if these conditions are noted on a bone-density scan. Gallstones, another complication frequently seen in primary sclerosing cholangitis patients, can be treated as they are in patients who do not have PSC. If infections occur in the bile ducts, they should be treated with antibiotics. Restricted salt intake as well as use of diuretics can help reduce swelling of the abdomen and feet, once PSC becomes cirrhosis. Patients who are deficient in vitamins A, D, and K can supplement their diets.
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Virtually every liver mass can be labeled as either benign (not cancerous) or malignant (cancerous). The only way to distinguish between the two is to perform a liver biopsy. Benign masses will not spread to other organs and may or may not pose problems.
Benign liver tumors occur in many forms, but five types are the most common: hemangiomas, hepatic adenomas, focal nodular hyperplasia, solitary liver cysts, and nodular regenerative hyperplasia. Each of these liver masses has its own unique characteristics, symptoms, and treatments. Hemangiomas. As their name describes, hemangiomas are filled with heme, or blood. They closely resemble the harmless red spots known as senile hemangiomas, which spontaneously appear on the chests and abdomens of senior citizens. The most common type of benign liver tumor, hemangiomas are estimated to occur in up to 20 percent of the population; about one-tenth of affected individuals-—more women than men—will have more than one. Hemangiomas also occur in the brain, lungs, or skin, and they crop up at any age.
Hemangiomas almost always remain small, and because they usually cause no symptoms, most people with these masses are not aware they are diere. Occasionally, the hemangioma will grow larger than a few centimeters and begin to cause pain in the upper right quadrant of the abdomen. If the hemangioma continues to expand, the tumor can begin to bleed, sometimes forming blood clots within itself and causing pain. Hemangiomas rarely bleed into the abdominal cavity, but it does happen—and this is an extremely serious and painful event that calls for emergency surgery.
Typically, hemangiomas are discovered during a sonogram or CT scan for an unrelated disorder. If the mass is larger than two and one-half centimeters, a tagged red blood cell (RBC) scan—a test that dyes the blood with a radioactive metallic element called a tracer—may be ordered. The RBC scan is a lengthy test; it takes about two hours for the tracer to accumulate in the hemangioma before the diagnosis is confirmed.
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