LIVER HEPATOBILIARY

Hepatobiliary Surgery is a resective surgery which is done to treat chronic diseases of pancreas and liver. This surgical treatment is often performed for benign and malignant diseases of the liver, pancreas, gallbladder, and bile ducts.

Get To Know Your Digestive System

In Asia, the prevalence of liver diseases is high. Conditions like jaundice, fatty liver associated with obesity, high alcohol consumption and metabolic conditions like high cholesterol and diabetes, to liver cirrhosis and cancer can all cause damage to the body’s Hepoto-Pancreato-Biliary (HPB) system – yet few understand its importance.

Made up of the liver, pancreas, bile ducts and gallbladder, each organ is intrinsically related, and they are all essential to the body’s digestive system. Together, they are responsible for over 3600 functions in the body, including processing food, absorbing nutrition and disposing off toxins and waste. Taking care of the HPB system through early detection is vital for patient’s overall health and to empower them to seek the right care.

 

DID YOU KNOW?

Our body sends signals when the organs are malfunctioning. Symptoms do not always relate to the seriousness of your disease. You may have no symptoms at all and have severe heart disease, requiring prompt treatment. People often take a wait-and-see approach, delaying because they think that what they are feeling is due to something else.

HPB System – The Liver

The liver is a vital organ, without which the tissues of the body would quickly die from lack of energy and nutrients. It performs many essential functions related to digestion, metabolism, immunity, and the storage of nutrients within the body. It is also the only organ in the body that has an incredible capacity for regeneration of dead or damaged tissues and it is capable of growing quickly to restore its normal size and function.

 

HPB System – The Pancreas 

The pancreas is a gland located at the upper back of the abdomen below and behind the stomach. It contains exocrine cells, which produce enzymes for digestion of food, and endocrine cells, which produce hormones for regulation of blood sugar levels. The pancreas has three main parts; head, body and tail. The head of the pancreas is next to the common bile duct (which drains bile from the liver) and duodenum (the first part of the intestine).

 

HPB System – The Biliary Tract

The biliary tract is made up of the gallbladder and bile ducts. The gallbladder is a pouch that connects to the mid-portion of the main bile duct, acting as a reservoir for bile while it is not being used for digestion. The main function of the bile duct is to transport bile, a liquid produced by the liver to the intestine where it helps with the digestion of food.

 

LIVER DISEASES 

Fatty liver and hepatitis B are the two most common liver diseases in Malaysia. A lifestyle-related liver condition, fatty liver could be the result of a sedentary lifestyle, inadequate activities and eating too much leading to an increase in body mass index (BMI). The risk factor of diabetes also negatively impacts the condition.

Hepatitis B is a disease characterised by the inflammation of the liver. The disease can progress to fibrosis (scarring) and cirrhosis or liver cancer. Since the prescription of a universal vaccination against hepatitis B, there has been a significant drop in incidences.

The health of the liver is determined by running a series of liver function tests that includes a group of blood tests to detect inflammation and damage to the liver. Individuals who belong to the high-risk group such as those with bad food habits, who lead sedentary lifestyles, with high BMI, diabetics as well as individuals with family members who have liver conditions or are carrriers of hepatitis B should undergo liver function tests even if they do not experience any significant sign of liver discomfort.

Once any liver disorder is detected from the blood tests, an ultrasound and further blood test will be prescribed to determine how advanced the condition is. After the liver condition has been determined, the next step is to prescribe treatment to prevent further injury to the liver, as well as to reduce the risk of downstream conditions.

Fatty liver can be prevented from escalath oral medication and lifestyle modification. Patients who are motivated to reduce calorie intake and exercise can reverse the liver condition. In fact, lifestyle changes are often more effective than medication.

In the case of hepatitis B, if the virus is active and there is ongoing injury to the liver, treatment is necessary and this comes in the form of antiviral oral medication. Thereafter, regular blood tests will be done to determine if the condition is under control.

Surgery becomes necessary in two situations, when liver cirrhosis leads to liver cancer, the operation only removes the cancer and leaves the remaining functioning liver and secondly if liver disease leads to liver failure, usually at end stage of liver cirrhosis in which case a transplant is needed. Liver transplantation is a surgical procedure whereby a diseased or failing liver is removed and replaced by a whole new liver from a cadaveric donor or part of a healthy liver from a living donor.

Although liver transplant is considered as the last option for patients with end-stage liver disease, nonetheless it offers patients hope for a second chance at life. Common types of liver transplantation are cadaveric and living donor liver transplantation.

In Asia, the prevalence of liver diseases is high, and there is an increasing demand for liver transplantation for patient with end-stage liver disease, not to mention a worldwide shortage of cadaveric (non-living) livers with a long waiting list in every country. Hence, Living Donor Liver Transplant (LDLT) has become an effective option for patients suffering with rapidly progressive liver disease like hepatocellular carcinoma (HCC) (the most common type of liver cancer), waiting for a deceased donor liver is often not ideal as that can take a long time. Without LDLT, such patients can develop fatal complications.

DOCTOR IN CHARGE

Dato' Dr. Tan Kai Chah

Dato' Dr. Tan Kai Chah

Consultant Hepatobiliary & Liver Transplant Surgeon

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