Definition & Overview

Hepato-pancreato-biliary disease refers to any condition that affects the liver, pancreas, gallbladder, and the bile ducts. These diseases commonly share some telltale signs or symptoms, such as jaundice, darker urine colour, and lighter stool colour. While some have genetic or hereditary causes, most are due to chronic damage to the tissues of the organs involved. These conditions are treated and managed by hepatologists, hepato-pancreato-biliary oncologists, and transplant specialists.

Causes of Condition

Below is the list of common hepato-pancreato-biliary diseases and their causes:

Liver disease

  • Liver cancer – Also known as hepatocellular carcinoma, liver cancer is caused by excessive alcohol consumption, birth defects that affect the liver, or chronic hepatitis infections. It is also associated with hemochromatosis, a hereditary condition causing abnormally high levels of iron in the liver.
  • Liver cirrhosis – This refers to the scarring of the liver, which prevents the organ from functioning well. The condition is most commonly caused by chronic alcohol abuse and chronic viral hepatitis B and C.
  • Viral hepatitis – Hepatitis is a medical condition characterised by the inflammation of the liver. It presents in many different types including acute hepatitis A, B, C, D, or E, as well as chronic hepatitis, depending on the specific type of hepatitis virus involved. One unique type, however, is alcoholic hepatitis caused by excessive alcohol consumption, usually accumulated over many years.
  • Infectious diseases of the liver – These include Epstein-Barr virus, yellow fever, rubella, leptospirosis, echinococcosis, amoebiasis, toxoplasmosis, and schistosomiasis.
  • Inflammatory conditions – These include liver abscess, phlebitis, sarcoidosis, and non-alcoholic steatohepatitis.
  • End-stage liver disease – Also known as hepatorenal syndrome, it is characterised by liver failure and occurs due to chronic liver damage.
  • Cystic diseases – These diseases are caused by the formation of cysts in the liver.
  • Vascular disorders - These include liver infarction, peliosis hepatis, or veno-occlusive disease.
  • Metabolic diseases – These include Rotor’s and Gilbert’s syndromes as well as Wilson’s disease, among several others.


Biliary disease

  • Gallstones – The formation of stones in the gallbladder is often due to high levels of cholesterol in the bile that the gallbladder releases.
  • Gallbladder cancer – The risk of gallbladder cancer is higher among patients who have gallstones or suffer from persistent or recurrent cholecystitis.
  • Bile duct cancer – Cancer of the bile duct occurs often due to cholangitis or sclerosis of the bile ducts.
  • Cholangitis – This is a condition characterised by the inflammation of the bile ducts.
  • Cholecystitis – This is a condition characterised by the inflammation of the gallbladder.


Pancreatic disease

  • Pancreatic cancer – This is a disease wherein the cells in the pancreas develop abnormal DNA mutations. As many as one-fourth of all pancreatic cancer cases are caused by cigarette smoking.
  • Pancreatitis – Known as the inflammation of the pancreas, this disease is caused by chronic alcoholism, gallstones, excessive cigarette smoking, cystic fibrosis, or a family history of the disease.


Other risk factors for hepato-pancreato-biliary disease include inflammatory bowel disease, Crohn’s disease, and ulcerative colitis.

Key Symptoms

The first signs of liver disease include:

  • Jaundice, or the yellowing of the skin and eyes
  • Abdominal pain
  • Abdominal swelling
  • Itchy skin
  • Swelling of the legs or ankles
  • Dark-coloured urine
  • Pale-coloured stool
  • Bloody stool
  • Chronic fatigue
  • Nausea
  • Vomiting
  • Bruising easily
  • Loss of appetite


As for gallstones and biliary tract diseases, the majority of patients are asymptomatic, but when symptoms do manifest, they usually include:

  • Abdominal pain in the upper right quadrant
  • Nausea
  • Vomiting
  • Severe pain that abates over several hours
  • Persistent pain accompanied by fever


Pancreatitis or pancreatic cancer, on the other hand, can cause the following symptoms:

  • Upper abdominal pain radiating to the back and tends to get worse when eating foods high in fat
  • Abdominal swelling
  • Tenderness in the abdomen
  • Fever
  • Nausea
  • Vomiting
  • Increased heart rate
  • Unexplained weight loss
  • Enlarged lymph nodes in the neck


Pancreatic cancer may also share the symptoms of liver cancer or end-stage liver disease, such as jaundice, dark urine, and light-coloured stool.

Who to See and Types of Treatments Available

Patients who are suffering from hepato-pancreato-biliary diseases or their symptoms should see a hepatologist, who can then make the necessary referral to hepatobiliary surgeons, pancreatic surgeons, or hepatobiliary surgical oncologists who specialise in treating specific types of hepato-pancreato-biliary diseases. There are currently several medical centres that specialise in HPB diseases.

There are several treatment options available for patients suffering from any liver, pancreatic, or biliary disease. In the case of cancer patients, the malignant cells can be removed and treated using laparoscopic radiofrequency ablation, regional chemotherapy, or internal radiation therapy. In the case of gallbladder or biliary tract disease, patients are initially advised to undergo a cholecystectomy. However, for severe conditions, such as in the case of liver cirrhosis and end-stage liver disease, patients may be required to undergo organ transplantation.

References:

  • Navaneethan U, Shen B. “Hepatopancreatobiliary manifestations and complications associated with inflammatory bowel disease.” Inflamm Bowel Dis. 2010 Sep; 16(9): 1598-619. http://www.ncbi.nlm.nih.gov/pubmed/20198712

  • Butte JM., Hameed M., Ball CG. “Hepato-pancreato-biliary emergencies for the acute care surgeon: etiology, diagnosis and treatment.” World Journal of Emergency Surgery. 2015; 10:13. https://wjes.biomedcentral.com/articles/10.1186/s13017-015-0004-y

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