What is this Condition?

Gallbladder cancer is rare, accounting for fewer than 1 % of all cancers. The disease occurs mostly in women over age 60. It progresses rapidly and has a poor prognosis because it’s usually diagnosed late.

Bile duct cancer accounts for approximately 3% of all cancer deaths in the United States. It occurs in both men and women between ages 60 and 70. Typically, the cancer spreads to local lymph nodes as well as the liver, lungs, and peritoneum.

What Causes it?

Many doctors consider gallbladder cancer a complication of gallstones, although this theory is based on circumstantial evidence ­ 60% to 90% of people with gallbladder cancer also have gallstones.

At diagnosis, the doctor often finds that the cancer has spread to the lymph nodes. Direct spread to the liver is common, and direct spread to both the cystic and common bile ducts, stomach, colon, duodenum, and jejunum also occurs, causing blockages. The cancer also spreads to the peritoneum, ovaries, and lower lung lobes.

The cause of bile duct cancer isn’t known; however, statistics show an unexplained increased incidence of this cancer in people with ulcerative colitis. This link may result from a common cause - perhaps an immune mechanism or chronic use of certain drugs by people with colitis.

What are its Symptoms?

The symptoms of gallbladder cancer are almost indistinguishable from those of gallbladder inflammation: pain in the upper middle or upper right part of the abdomen, weight loss, loss of appetite, nausea. vomiting, and jaundice. However, chronic, progressively severe pain in someone without a fever suggests cancer. In people with simple gallstones, pain is sporadic. Another telling clue to cancer is a palpable gallbladder with obstructive jaundice. Some people may also have an enlarged liver and spleen.

Progressive profound jaundice is commonly the first sign of obstruction due to extrahepatic bile duct cancer. The jaundice is usually accompanied by chronic pain in the upper middle or upper right part of the abdomen, radiating to the back. Other common symptoms include itching, skin problems, loss of appetite, weight loss, chills. and fever.

How is it Diagnosed?

No one test can diagnose gallbladder cancer. However, lab tests support this diagnosis when they suggest liver problems and extrahepatic biliary obstruction.

How is it Treated?

Surgery relieves symptoms but doesn’t cure the disease. It includes various procedures, such as gallbladder removal, common bile due exploration, tube drainage, and wedge excision of liver tissue. Surgery should normally be performed to relieve obstruction and jaundice that result from extrahepatic bile duct cancer.

Other measures to help relieve symptoms include radiation, radiation implants (mostly used for local and incisional recurrences), and chemotherapy (with combinations of fluorouracil, doxorubicin, and lomustine). All of these treatment measures have limited effects.

What can a Person Undergoing Surgery do?

• After biliary surgery, you’ll probably want to take shallow breath. To improve your breathing, you may receive pain relievers and be instructed to splint your abdomen with a pillow or an abdominal binder.
• Be aware that you’ll have a nasogastric tube in place for 24 to 72 hours after surgery to relieve distention, as well as a T tube.

What is this Condition?

Appendicitis is a medical emergency in which the appendix is inflamed due to obstruction and may rupture and spread infection. This is the most common major surgical emergency, affecting men and women equally. Left untreated, appendicitis is fatal, but surgery is an effective cure. Also, the use of antibiotics has helped reduced the number of cases and, thus, the death rate.

What Causes it?

Appendicitis is probably the result of an obstruction in the tube that passes through the appendix from the intestine. This blockage may be caused by a bit of stool, constriction of the tube, or a viral infection. The obstruction causes inflammation, which may lead to infection, a clot, tissue decay, and perforation. If the appendix ruptures or perforates, the infection spills into the abdominal cavity, causing the most common and dangerous complication of appendicitis - peritonitis.

What are its Symptoms?

Symptoms usually occur in the following sequence:

• pain in or around the upper right abdomen

• loss of appetite, nausea, and vomiting

• pain concentrated in the lower right abdomen, with a “boardlike” abdominal rigidity

• increasing tenderness, increasingly severe abdominal spasms and, almost always, soreness to the touch

• lower left side too tender to touch, suggesting the lining of abdomen is inflamed

• constipation (possibly diarrhea), slight fever, and rapid heartbeat

• abdominal pain that ends suddenly (usually means that the appendix has perforated or burst).

How is it Diagnosed?

Your doctor will ask about symptoms, check for tenderness, and look for a mild fever and a moderately high white blood cell count. The physical exam and blood test rule out many illnesses with similar symptoms.

How is it Treated?

Appendectomy, surgery to remove the appendix, is the only effective treatment. Laparoscopic appendectomies, performed through very small incisions, shorten the recovery time.

If the infection has spread and peritonitis develops, the doctor will use antibiotics to fight it and tubes to drain the abdominal cavity.