Hepato Pancreato Biliary (HPB) is any condition that affects the pancreas, liver, gallbladder, and the bile ducts. These conditions share the same symptoms such as darker urine color, jaundice, and lighter stool color. Hepato pancreato biliary conditions are treated and managed by a multidisciplinary team comprising of hepatologists, transplant specialists, and hepato pancreato biliary oncologists.
Causes of HPB Conditions
Some of the causes of HPB conditions are genetic but most of the conditions are often due to chronic damage to the tissues of the organs involved.
Below are some of the main HPB conditions and their causes:
Pancreatic Disease
There are different types of pancreatic diseases and they include:
- Pancreatitis: This is also known as inflammation of the pancreas and it is caused by excessive cigarette smoking, chronic alcoholism, cystic fibrosis, gallstones, of genetics.
- Pancreatic cancer: Most pancreatic cancers are caused by cigarette smoking.
Liver Disease
The different types of liver conditions and their causes include:
- Liver cirrhosis: This is the scarring of the liver which prevents it from functioning well. It is commonly caused by chronic hepatitis B and C and chronic alcohol abuse.
- Liver cancer: This is also known as hepatocellular carcinoma and it is caused by chronic hepatitis infections, excessive alcohol consumption, or birth defects which affect the liver. Liver cancer is also associated with hemochromatosis which is a genetic condition that causes high levels of iron in the liver.
- End-stage liver disease: This is also known as hepatorenal syndrome and occurs due to chronic liver damage.
- Infectious liver diseases: These include yellow fever, rubella, Epstein-Barr virus, echinococcosis, leptospirosis, toxoplasmosis, amoebiasis, and schistosomiasis.
- Viral Hepatitis: This is characterized by inflammation of the liver and there are different forms of it including chronic hepatitis, acute hepatitis A, B, C, D, and E, and alcoholic hepatitis.
- Inflammatory conditions: They include phlebitis, liver abscess, sarcoidosis, and non-alcoholic steatohepatitis.
- Vascular conditions: They include peliosis hepatis, veno-occlusive disease, and liver infarction.
- Metabolic conditions: They include Gilbert’s and Rotor’s syndrome as well as Wilson’s disease.
- Cystic disorders: These are caused by formation of cysts in the liver.
Biliary Disease
The different types of biliary diseases include:
- Bile-duct cancer: This occurs due to cholangitis or sclerosis of the bile duct.
- Gallbladder cancer: Gallbladder cancer risk is higher in patients suffering from recurrent cholecystitis or have gallstones.
- Gallstones: These often form due to high levels of cholesterol in the bile that the gallbladder releases.
- Cholangaitis: This is characterized by bile ducts inflammtion.
- Cholecystitis: This is characterized by the inflammation of the gallbladder.
Symptoms of Hepato Pancreato Biliary diseases
Symptoms of pancreatitis or pancreas cancer include:
- Abdominal swelling
- Abdominal tenderness
- Upper abdominal pain which gets worse after eating fatty foods
- Jaundice
- Dark urine
- Light colored stool
- Nausea
- Vomiting
- Fever
- Unexplained weight loss
- Increased heart rate
- Enlarged lymph nodes in the neck
The initial symptoms of liver disease include:
- Abdominal pain
- Abdominal swelling
- Jaundice
- Swelling of the ankles or legs
- Itchy skin
- Pale-colored stool
- Bloody stool
- Dark-colored urine
- Chronic fatigue
- Nausea
- Vomiting
- Chronic fatigue
- Loss of appetite
- Easily bruising
Symptoms of gallstones and biliary tract conditions are usually asymptomatic in the initial stages, but they start to show later as they manifest. They include:
- Nausea
- Vomiting
- Abdominal pain in the upper quadrant
- Persistent pain accompanied by fever
Diagnosing HPB
Diagnosing HPB involves disclosing your health history to your physician and undergoing a physical exam as well as other diagnostic tests which include:
- X-ray: This uses electromagnetic beams to show images of bones, internal tissues, and organs.
- MRI: This utilizes radio waves, large magnets, and a computer to make detailed images of structures and organs within the body.
- CT scan: This uses x-rays and a computer to show detailed images of the bones, muscles, fat, and organs. This test is more detailed than an x-ray.
- Cholecystography: Also known as oral cholecystography or a gallbladder series, it involves swallowing a special contrast dye before a series of x-rays are taken of the gallbladder. This test can show inflammation of the gallbladder, gallstones, and other conditions.
- Liver biopsy: Tissue samples from the liver using a needle and observed under a microscope.
- Laparoscopy: This test uses a laparoscope (long, thin tube with a camera and light at the end) which is inserted into the abdomen through a small incision to check the abdomen’s contents and remove tissue samples.
- Ultrasound: Also known as sonography, it uses high frequency sound waves and a computer to create images of organs, tissues, and blood vessels as well as check the blood flow through the blood vessels.
- Percutaneous transhepatic cholangiography: This involves inserting a needle through the skin and into the liver. Contrast dye is then injected through the needle which enables the bile duct to be seen through an x-ray.
- Hepatobiliary scintigraphy: This is an imaging test of nuclear medicine that is used to view the bile duct, liver, gallbladder, and upper part of the small intestine.
- Esophagogastroduodenoscopy (EGD): Also known as upper endoscopy, it enables the physician to view inside the esophagus, stomach, and duodenum through an endoscope (a thin, flexible, lighted tube).
- Endoscopic retrograde cholangiopancreatography (ERCP): This procedure is used to diagnose and treat conditions gallbladder, bile duct, liver, and pancreas. It involves using an endoscope to examine the esophagus, stomach, and duodenum.
Treatment of HPB conditions often involves a multidisciplinary team.
HPB surgical procedures include:
- Liver tumor ablation
- Liver resection (minor and major)
- Pancreas resection for benign and malignant conditions –including Whipple procedure
- Bile duct repair
- Bile duct resection
- Complex gallbladder resection
All of the above surgical procedures can be performed using a minimally invasive technique when appropriate.
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