Childhood Liver Diseases

Liver

Liver

OESOPHAGUS:

Esophagus is the food pipe through which food passes, from the pharynx to the stomach. It is about 25 cm long in adults. The esophagus may be affected by gastric refluxcancer, prominent dilated blood vessels called varices that can bleed profusely, and disorders of motility. Diseases may cause difficulty in swallowing (dysphagia), painful swallowing (odynophagia), chest pain, or cause no symptoms at all. Clinical investigations include X-rays when swallowing bariumendoscopy, and CT scans.

Treatment offered:

  • Oesophageal malignancy or corrosive stricture = Oesophagectomy with Oesophageal Replacement (stomach or colonic conduit) – Transthoracic or transhiatal
  • Zenker’s diverticula = Esophageal Diverticulectomy
  • gastroesophageal reflux disease (GERD) = Laparoscopic Fundoplication

 

STOMACH:

The stomach is located between the esophagus and the small intestine. Its main function is digestion and storage of food. The stomach may be affected by gastritis, peptic ulcer

disease, stomach cancer and pyloric stenosis. Diseases may cause pain in epigastric region, non bilious vomiting, early satiety and abdominal fullness.

Treatment offered:

  • Stomach cancer = Distal gastrectomy, subtotal or total gastrectomy
  • Pyloric stenosis = Pyloromyotomy
  • Palliative Procedures = Laparoscopic / Open Gastro-jejunostomy, Celiac Plexus Block

 

SMALL BOWEL:

Small Intestine is a part of the gastrointestinal tract between the stomach and the large bowel.  The small intestine has three parts- Duodenum, Jejunum and Ileum. The primary function of small bowel is the absorption of nutrients and minerals from food. Small bowel may be affected by appendicitis, meckel’s diverticula, strictures and malignancy.

Treatment offered:

  • Acute appendicitis = Laparoscopic Appendectomy
  • Meckel’s diverticula = diverticulectomy
  • Benign strictures or malignancy = Resection & Anastomosis

 

LARGE BOWEL:

Large intestine is the last part of the gastrointestinal tract. Water is absorbed here and remaining waste material is stored as feces before being removed by defecation. It has two parts- colon and rectum. Large bowel may be affected by Inflammatory Bowel Disease, Acute Inflammatory Diseases, Rectal Prolapse, Haemrroids and Malignancy. Disease may cause constipation, blood in stool, and abdominal distension.

Treatment offered:

  • Segmental Colonic Resections- Right/left hemicolectomy, Transverse colectomy, sigmoidectomy
  • Total abdominal colectomy with Ileorectal anastomosis
  • Total proctocolectomy with ileal pouch anal anastomosis
  • Lap anterior resection
  • Lap Abdomino-perineal Resections

 

GALL BLADDER:

Gallbladder is a hollow organ where bile is stored and concentrated before it is released in small intestine.  Humans can live without a gallbladder. Common gallbladder problems are gallstone disease and cancer, they usually manifest with pain in right upper abdomen or found incidentally.

Treatment offered:

  • Gallstone Disease: Laparoscopic cholecystectomy
  • Gall Bladder Cancer: Radical Cholecystectomy including Multiorgan Resections +/- Wedge/ anatomical liver resection + Extended portal lymphadenectomy

 

BILE DUCT: 

Bile duct is a long tube like structure that carry bile from liver to gastrointestinal tract. Bile, required for the digestion of food. Blockage of the bile duct by stonesscarring from bile duct injury, or cancer prevents the bile from being transported to the intestine and the active ingredient in the bile (bilirubin) instead accumulates in the blood. This condition results in jaundice, where the skin and eyes become yellow from the bilirubin in the blood. This condition also causes severe itching/pruritis from the bilirubin deposited in the tissues. In certain types of jaundice (surgical obstructive jaundice), the urine will be noticeably darker, and the stools will be much paler than usua

Treatment offered:

  • Choledochal Cysts: Excision of Choledochal Cyst with Hepaticojejunostomy.
  • Biliary Atresia: Kasais procedure, Liver Transplant.
  • CBD Stone: Laparoscopic / Open CBD Exploration, Choledocodudenostomy or hepaticojejunostomy
  • Bile Duct Strictures: Roux en Y Hepaticojejunostomy.
  • Bile Duct cancer (hilar cholangicarcinoma) : Right/Left extended hepatectomy with Caudate Lobe Resection +/- portal venous resection

 

Pancreas:

Pancreas is a digestive organ, secreting pancreatic juice containing digestive enzymes that assist digestion and absorption of nutrients in the small intestine. It is also an endocrine organ producing several important hormones, including insulinglucagonsomatostatin, and pancreatic polypeptide which circulate in the blood and have important role of blood sugar control within the body. Anatomically, the pancreas is divided into head, neck, body and the tail of pancreas. The head is surrounded by the duodenum in its concavity. Common conditions that may affect pancreas are inflammation of pancreas (pancreatitis) or pancreatic cancer, which usually manifests as pain in upper abdomen radiating to the back, and sometimes with jaundice.

Treatment offered:

  • Acute severe necrotizing pancreatitis = lap/open necrosectomy
  • Pancreatic pseudocyst= lap/open cystogastrostomy/cystojejunostomy
  • Chronic pancreatitis= Drainage procedure (Lateral pancreaticojejunostomy), Drainage + Resection procedure [head coring with Lateral pancreaticojejunostomy (Frey’s procedure), Whipple’s pancreatico-duodenectomy]
  • Periampullary carcinoma= Whipple’s pancreatico-duodenectomy +/- Portal venous resection
  • Carcinoma body & tail of the pancreas= Distal pancreatectomy with or without splenectomy (spleen preserving)

 

LIVER:

The liver is a vital organ and it has a wide range of functions, including detoxification of various metabolitesprotein synthesis, and the production of biochemicals necessary for digestion. Liver is the only organ that has a remarkable capacity to regenerate and grow back again. The classic symptoms of liver damage are Pain in the upper right quadrant, Jaundice (yellow skin and/or whites of the eyes), Swelling of the abdomen, ankles and feet, Pale stools, Dark urine, Excessive fatigue and Bruising and easy bleeding.

Treatment offered:

LIVER TRANSPLANTATION– Live Related Liver Transplantation/Deceased Donor Liver Transplantation

 

LIVER RESECTIONS :

  •   Right/left hepatectomy
  •   Extended Right/left hepatectomy
  •   Segmentectomy
  •   Sectionectomy (right posterior sectionectomy,
  •   left lateral sectionectomy)
  •   Central hepatectomy
  •   Caudate lobectomy
Benign Diseases:

  • Hydatid cyst
  • Symptomatic hemangioma
  • Liver adenoma
Malignant Diseases:
  • Hepatocellular carcinoma
  • Intrahepatic cholangiocarcinoma
  • Metastatic colorectal cancer
  • Metastatic or Primary neuroendocrine tumors
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PERCUTANEOUS PROCEDURES

  • Portal Vein embolization (PVE)
  • Transarterial chemoembolization (TACE), for Liver Tumours, Metastases
  • Transarterial radioembolization (TARE)
  • Radiofrequency ablation

 

PORTAL HYPERTENSION:

Portal hypertension is an increase in pressure within the portal venous system and its branches, which draining most of the intestine to the liver. It is defined as a hepatic venous pressure gradient equal to or more than 5 mm of hg. The most common cause of portal hypertension is liver cirrhosis followed by non cirrhotic portal hypertension (NCPH).

Treatment offered:

  • EHPVO/ NCPF: Proximal Splenorenal Shunt
  • Refractory GI Bleed: Portocaval, Oesophageal Devascularization Procedures.

Portal Biliopathy: PSRS, Hepaticojejunostomy

 

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