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Sunday November 5, 2006

An inflamed duct


What’s making Hong Kong entertainer Lydia Shum ill? She is said to be suffering from cholangitis, an inflammation of the bile duct. 

BY TEO CHENG WEE 

CALL it a lame duct. Cholangitis, or inflammation of the bile duct, can lead to severe illness and even death. It is something that veteran Hong Kong comedienne Lydia Shum, 59, is said to suffer from, as she struggles for her life in a hospital in Hong Kong. News first broke of her illness earlier this month, when her daughter Joyce Cheng told the press that Sum was “critically ill” after bile-duct surgery.  

Reports surfaced that the latter has suf fered from cholangitis since 1986, and had 36 gallstones removed in 2002. Other reports say that the actress, nick named Fei Fei (fatty) for her girth, also had liver cancer – a claim her family has denied. One thing is for sure: Shum’s weight increases her risk of bile-duct infection, doc tors say.  

The bile duct carries bile, a golden-brown liquid used for digestion, from the liver (where it is made) to the gallbladder and then to the small intestine.  

But sometimes, the duct gets blocked. Usually, this is because gallstones (hard lumps made up of cholesterol, bile salt, blood pigment and calcium) have migrated from the gallbladder to the bile duct. Other times, it is caused by tumours growing in the duct. The blockage causes bacteria, which usually reside in the digestive tract without prob lems, to accumulate and results in an infec tion, says Dr Chew Soo Ping, a senior consul tant hepato-biliary and pancreatic surgeonfrom Mount Elizabeth Hospital. When that happens, the person may suffer symptoms like fever, abdominal pain and jaundice. It becomes life-threatening when bacteria seeps into the blood stream, releasing toxins that damage other organs. The risk of dying might be as high as 30%, says Dr Chew. To treat it, doctors can insert an endoscope – a slim, flexible tube – into the bile duct to remove the gallstone. This is done with a “wire basket” that catches the stone and pulls it into the intestine, where it is then passed out in the stool.  

They will also operate on the patient to remove the gallbladder, so as to prevent future gallstone formation. The gallbladder, which stores and processes bile, is useful for aiding digestion, but is not essential.  

The patient is also given antibiotics to counter the associated bacterial infection. Gallstone formation is likely due to imbal ance or changes in the chemical composition of bile present in the gallbladder or the bile duct, says Dr Dede Sutedja, a senior consul tant gastroenterologistat National University Hospital.  

They include increased amounts of choles terol, pigments and certain bile acids. Changes in bile composition can happen when the body goes through hormonal changes, like during pregnancy and rapid weight loss, or when taking oral contracep tives.  

Overweight people are also at greater risk due to their usually higher cholesterol levels. Gallstones formed in the gallbladder do not always move to the bile duct. If the gallstone stays in the gallbladder without the person showing any symptoms, he need not go for an operation, says Dr Sutedja. But if symptoms arise, it becomes neces sary to remove the gallstone, and usually the whole gallbladder, too. This is to prevent gall bladder and bile-duct infection. Around the world, the incidence rates of gallstones is 10% to 15%, but only 3% to 5% of these people will have bile-duct infection, says Dr Chew. In rare cases, however, gallstones are formed in the bile duct itself – a condition known as recurrent pyogenic cholangitis (RPC), says Dr Law Ngai Moh, a consultant gastroenterologistfrom Raffles Hospital. He adds that RPC can occur even after the gallbladder has been removed and Shum’s symptoms suggest that she may be suffering from it.  

RPC is more serious because gallstones can keep forming in the bile duct. Endoscopic procedures and surgical operations may need to be performed repeatedly to clear them. Worse, these gallstones may be formed in the liver, where the endoscope cannot reach. Antibiotics can be given to treat the infec tion if the blockage is not too serious.  

But an operation – or several – may be necessary if the blockage is severe, says Dr Chew. Dr Law says chronic infection and inflam mation could also lead to mutation of the bile-duct cells, causing bile-duct cancer – which is a form of liver cancer.  

Things may look bleak for the bubbly Sum but fans can take heart that Cheng has recent ly come out to refute reports of the actress’ death. She said: “My mother is very much alive, thank you.” – The Straits Times, Singapore/Asia News Network 

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