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Sunday November 5, 2006
What’s making Hong Kong entertainer Lydia Shum ill?
She is said to be suffering from cholangitis, an
inflammation of the bile duct.
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
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
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
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
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
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.
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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