YOGA FOR BILIARY TRACT DISEASE

MÜKAM KARÔTI VACÁLAM

PANGUM LANGHAYATÄ GIRIM

YATKRIPÁ TAMAHAM VANDÄ

PARAMÁNANDA SÁGARAM

PRAYER

Name of the disease & terminologiesEtiologyHistory, signs and symptomsPhysical examination InvestigationTreatment according to allopathic medicineOther therapiesYoga practicesBooks and journals for reference

Liver is the largest gland of the body, lying beneath the diaphragm in the right hypochondrium and upper part of the epigastrium.

It is of irregular shape and weighs from 1 to 2 kg, or about 140 the weight of the body.

It secretes the bile and is also of great importance in both carbohydrate and protein metabolism.

DISEASES OF THE LIVER AND BILIARY TRACT

The biliary system is the organs and duct system that create, transport, store, and release bile into the duodenum (the first part of the small intestine) for digestion.

The biliary system consists of the gallbladder, bile ducts inside the liver, and bile ducts outside the liver, including the hepatic ducts, common bile duct, and cystic duct.

Biliary tract disease or choledocholithiasis – presence of a gallstone in the common bile duct

One of the most common causes of extrahepatic biliary obstruction is choledocholithiasis with one or more stones in the common bile duct or common hepatic duct causing biliary obstruction.

DEFINITION

Up to 10% of patients with gallstones have common bile duct stones.

Common bile duct stones have been discovered days to several years after surgery in as many as 5% of patients who have undergone cholecystectomy.

It is believed the stones represent either retained stones or stones that have formed de novo after the operation.

PREVALENCE

Stones in the bile duct can cause biliary obstruction and cholestasis.

This can lead to infection in the bile duct (bacterial cholangitis) which requires urgent medical therapy.

The longstanding presence of stones in the bile duct can lead to secondary biliary cirrhosis.

Choledocholithiasis can also lead to gallstone pancreatitis.

PATHOPHYSIOLOGY

The majority of patients with choledocholithiasis report upper abdominal pain although some patients may remain asymptomatic.

Because complete obstruction of the bile duct by the stone may be intermittent, patients may report episodic jaundice.

The initial presentation of choledocholithiasis can also be heralded by an episode of cholangitis.

Gallstone pancreatitis presents with typical features of pancreatitis including epigastric pain, nausea, and vomiting.

SIGNS AND SYMPTOMS

Ultrasound is the preferred initial screening test as it is usually less expensive than abdominal CT scan, does not use ionizing radiation, and is very accurate in detecting gallbladder stones and bile duct dilatation.

Abdominal CT scanning can also be very helpful in evaluating patients with obstructive jaundice. It is more accurate than ultrasound in detecting common duct stones and may help localize the level of obstruction in the biliary tree.

DIAGNOSIS

Magnetic resonance cholangiography is also gaining acceptance as a tool for diagnosing choledocholithiasis. Its accuracy in detecting bile duct stones is offset by its expense and lack of availability in some centers.

Once biliary dilatation or the presence of a common duct stone is noted on an imaging study, or biliary obstruction is strongly suspected on clinical grounds despite negative imaging studies, endoscopic retrograde cholangiopancreatography (ERC) is recommended. ERC provides a means of visualizing the biliary tree and the opportunity for therapy.

Percutaneous transhepatic cholangiogram can be a useful alternative when ERC is not successful, although it is sometimes not successful in the absence of dilated bile ducts.

The goals of therapy for choledocholithiasis are to remove the stone from the biliary tree and to urgently decompress the biliary tree if bacterial cholangitis is present.

Stone extraction can be accomplished with ERC often preceded by an endoscopic sphincterotomy.

In the presence of bacterial cholangitis when a stone cannot be removed for technical reasons due to, for eg., its large size, an endoscopically placed biliary stent can be useful for decompressing the biliary tree.

THERAPY

An alternative to ERC for treatment of choledocholithiasis is percutaneous transhepatic cholangiography (PTHC).

PTHC can be used for emergent drainage of the biliary tree in the presence of cholangitis.

Passage of a wire into the duodenum via a percutaneous approach can also help guide an endoscopist in performing an ERC with stone extraction where ERC previously failed technically.

YOGA PRACTICES

YOGA IS BALANCE (SAMATVAM)

I A Y T CORRECTS IMBALANCES

AIMS :

• STRESS REDUCTION

• RELIEF OF PAIN

• MEDICATION REDUCTION

Ánandamaya KôùaÁnandamaya KôùaVijòanánmaya Vijòanánmaya

KôùaKôùa

PERFECTPERFECTHEALTHHEALTH

Manômaya KôùaManômaya Kôùa

Ann

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Ann

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Pranamaya K

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Pranamaya K

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DH

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VY

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HIS

Panchakosa concept

General considerations: Acute problems, especially if associated with inflammation, require medical aid.

Contraindications: No practices pressing or moving this area (such as Nauli) are advisable.

Recommendations: Proper medical care can be supplemented by relaxation which decreases most types of pain. Laghoo Shankhaprakshalana can be according to Yoga tradition used in non-acute problems.

SPECIFIC PRACTICE