ANATOMY AND PHYSIOLOGY LIVER JAUNDICE

In terms of the current conditions, we are primarily dealing with four major organs: the liver, the pancreas, the gall bladder and the small intestine. The areas of concern are where they come together, not actually the organs themselves. As a brief introduction, the liver has two primary functions, producing bile and producing insulin. For now, the insulin production that leads to maintaining proper blood sugar levels is of little importance. After the liver produces bile, it sends it to the gallbladder and the small intestine along the same pathway, the ducts (hepatic, cystic and common bile ducts). The hepatic and the cystic ducts are fairly short and primarily move the bile from the liver to the gallbladder. At that point, they seem to merge to become the common bile duct, which passes into the beginning of the small intestine, an area called the duodenum. The gall bladder serves as a holding tank for bile that is used to digest a particularly large or fatty meal. It served a great function when humans ate rare, but extremely large and uncooked meals of animal flesh. Now, other than the fast food epidemic, the liver secretes enough bile to handle typical meals and so the gallbladder could be removed without any real medical consequences. Physically, the gallbladder is fairly small (4 cm or 2 in.) and is lodged almost entirely in the side of the liver. The other organ of interest here is the pancreas. This is a fairly large and complex organ whose primary purpose appears to be creating enzymes for digestion. After it produces these enzymes, it then secretes them into the duodenum (fancy word for start of the small intestine) at the same or nearly the same point as the common bile duct from the liver and gallbladder. So, why is all this important? When Ray was experiencing intense pain, the cause was a blocked bile duct, therefore backing up the gallbladder, the liver and the pancreas. The systemic results of this were then pancreatitis and jaundice. Pancreatitis is caused when the pancreatic duct is blocked and therefore, the enzymes upset the balance of the pancreas and cause swelling and digestion of the organ itself. Clearly not a good thing. Jaundice is a condition where the ducts are blocking the bile from exiting the liver and gallbladder. Therefore, the liver is no longer in balance and can no longer absorb fats and regulate blood sugar. The first observable symptom of this is that the body (starting with the eyes) turns a great shade of yellow. This is how Ray got the nickname the Yellow

Crayon. This improper liver function is what led the docs to think of hepatitis (a fancy term for swelling of the liver). Hepatitis can be caused by many things, but the famous cause is of course the highly transmittable virus that we hear so much about in the other parts of the world. So here is the kickerif all this can be traced so convincingly to a blocked common bile duct where it enters the duodenum, then why havent we solved the problem? Well, if you do your research, the most common (virtually the only one mentioned) cause for this blockage is gallstones. Gallstones are either cholesterol-based or calcium and bilirubin(iron)-based deposits in the gallbladder. I picture something similar to a clam with an oyster. Gallstones themselves are actually quite common today and can pose no threat, or be significant, based on the individual case. The most obvious thing in Ray was that a gallstone had passed from the gallbladder and was now lodged in the bile duct. They did an ultrasound and indeed found gallstones, so everybody thought we had it all wrapped up. It is a reasonably proven procedure to use an endoscope (tube down the throat) to get into the small intestine, reach up into the common bile duct and grab or break the gallstone blocking the way. This is often followed up by removing the gallbladder after the patient regains some level of health and stability. No big deal. Well, they did this and found that indeed the duct was blocked, but not with a stone. The duct appeared to be swollen shut rather than blocked. Therefore, this procedure did not reap the benefits that we had all hoped. Instead, they placed a stent in the duct to hold it open for the time being. This has allowed Rays return to health and happiness, but the cause of the problem is still unresolved and undiagnosed. As you can see, this area is very tightly packed. Therefore, working on the bile duct can be very tricky and very risky. This is the primary reason why the doctors are recommending so much time be invested in proper diagnosis before any real invasive action is taken. It is reasonable to believe that the Mayo clinic in Rochester is one of the best places available to work on this.