Elderly Grandmother has liver blockage

  : : My husband's elderly grandmother (89) is undergoing tests right now to check a blockage in her liver. She's had three tests now and Dr.'s are still not certain whether she has a cyst or a tumor.So far she has had a test where they inject the liver with dye and then last week she had a CAT scan and today she had the ERCP test. Still nothing and she is scheduled to have some other type of scan tomorrow. She has been sick for a month or more now, her liver is enlarged and she is jaundiced and feeling really bad. Is this diagnostic testing normally supposed to take this long? She's been testing for 10 days now and is miserable (this woman rarely complains and she was ready to be done with all of this last Tuesday). How long can she go with her liver not functioning correctly? I am worried that her body may start to fail her( also has high blood pressure and angina) because she has been sick for so long.
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  : Dear Allison:
  : By your description of the illness and the investigations that your husband's grandmother underwent, I assume that she has obstruction of the bile duct.   In an elderly person who has biliary obstruction without evidence of gallstones, one has to worry about malignancy causing the obstruction.  The most common causes of painless biliary obstruction are cholangiocarcinoma (cancer of the bile duct), tumor at the head of pancreas, and tumor spread to the lymph nodes surrounding the bile duct.  Chromic pancreatitis can also cause bile duct obstructio and jaundice..
  : ERCP is the test of choice for the evaluation of biliary obstruction in the lower bile duct.  During ERCP a stent can be inserted to allow bile to pass into the duodenum, thereby relieving the obstruction.  From your description, it seems that the ERCP did not or could not relieve your grandmother's biliary obstruction.  The next step is then to relieve the obstruction by a drainage catheter placed through the skin into the bile duct proximal to the obstruction (percutaneous transhepatic cholangiogram with drainage) by interventional radiologist (radiologist with special skills).  She should also be treated with antibiotics to prevent bile duct infection due to the obstruction.
  : Although your grandmother has jaundice, one does not necessarily conclude that the liver is not functioning properly.  The major risks at present are infection and deterioration due to spread of the presumed tumor,
  : This information is presented for educational purposes only.  Always ask specific questions to your personal physician,  If you wish a second opinion, we would be happy to see your grandmother in the Division of Gastroenterology at Henry Ford Hospital.  You can arrange an appoinment with Dr. ben Menachem, one of our experts in bile duct tumors, by calling [phone].
  : HFHSM.D.-jg
  : *keywords: bile duct cancer
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Dear Allison,
the course that you descrtibe is compatible with cancer of the pamcreas.  A drainage procedure (either endoscopic or surgical) will relieve the jaundice and itching, if this is aproblem, but will not increase survival.
This information is presented for educational purposes.  Always ask specific questions to your personal physician.