Introduction
Any obstruction, injuries, tumors, leakages, or lesions in the pancreas and the bile ducts can lead to disorders that are termed pancreaticobiliary diseases. The pancreas is an organ that serves both exocrine and endocrine functions in the body. It produces gastric enzymes such as amylase, peptidase, and lipase, which help digest carbohydrates, proteins, and fats. It also secretes hormones insulin and glucagon, which regulate the blood glucose levels in the body. Insulin helps convert glucose into energy in the liver, whereas glucagon initiates glucose storage in the body. The bile duct is the transporting medium for bile from the liver to the gallbladder and further to the small intestine for digestion. Conditions that affect the pancreas and bile duct are gallstones, pancreatitis, choledocholithiasis, cystic lesions of the pancreas, congenital diseases of the pancreas, and stones and strictures of the pancreas.
What Are Pancreatobiliary Diseases?
The diseases affecting the pancreas or bile ducts are listed:
Pancreatitis: The inflammation of the pancreas, which can be due to any infection or autoimmune. It can be acute or chronic. Acute pancreatitis shows sudden symptoms which subside in a few days. However, chronic pancreatitis presents prolonged symptoms of pain and discomfort. The symptoms of acute pancreatitis include pain in the upper abdomen, which can radiate to the back, fever, nausea, vomiting, and tenderness on touching the abdomen. Chronic pancreatitis presents symptoms such as weight loss, abdominal pain that increases after eating, and smelly and greasy stools (steatorrhea). Pancreatitis can be caused due to gallstones, consumption of alcohol, increased triglyceride levels in the blood, abdominal surgery, or injury. The treatment of the disease includes medications such as painkillers to cure the symptoms and avoiding eating something for a few days so that the pancreas gets time to recover.
Autoimmune Pancreatitis: is a chronic inflammation caused by the attack of the body's immune system. It is divided into type 1 (immunoglobulin G4- related) and type 2. Type 1 can affect multiple organs, including the pancreas, liver, bile ducts, and kidneys. Type 2 autoimmune pancreatitis affects only the pancreas.
Gallstones: Gallstones are deposits of digestive juices that are hard and can block the biliary ducts or cause problems in the gallbladder. It can vary in size from a small grain of sand to as large as a golf ball. It can be formed in either several numbers or as just one. The symptoms developed by gallstones are rapidly intensifying pain in the upper right portion of the abdomen, which can radiate to the back and the right shoulder. There are two types of gallstones:
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Cholesterol Gallstone: Cholesterol Gallstone is the most common type of gallstone composed of undissolved cholesterol and other components and appears yellow.
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Pigment Gallstones: These are formed due to a higher concentration of bilirubin in the bile and appear dark brown.
The treatment for gallstones includes either surgical removal of gallstones or medications which help to dissolve the gallstones. Surgical removal is suggested if the gallstones are larger or more in number. Whereas in cases of small and few gallstones, it is advised to dissolve them with medicines.
Congenital Anomaly of the Biliary Tract: The term congenital states that the condition is present from birth. The anomalies can be of two types mainly:
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Cystic Congenital Anomalies: Sac-like structures which are filled with pus or fluid.
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Non-cystic Congenital Anomalies: Unusual growth which may generally resemble the organ itself.
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Some common symptoms caused by congenital anomalies of the biliary duct are abdominal pain, jaundice (yellowish discoloration of eye sclera, mucus membrane, and skin), inflammation of the pancreas, cholangitis, and vomiting. The treatment of the anomaly depends on the type, whether it is cystic or non-cystic.
Cystic Lesions of the Pancreas: Different types of benign and malignant lesions of the pancreas are classified under the pathological classification of simple retention cysts, pseudocysts, and cystic neoplasms. The benign cysts are further divided into epithelial cysts and non-epithelial cysts.
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Retention Cysts: These are also known as simple or true cysts with no clinical significance. They are found in approximately 25 % of cases of cystic fibrosis and are usually small with no required treatment.
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Pseudocysts: These cysts result from acute pancreatitis with some degree of necrosis. These cysts contain pancreatic fluids such as enzymes (amylase, lipase) and are attached to the pancreatic ducts. They are called pseudocysts because they do not have a true wall of pancreatic cells. The walls of the pseudocyst are made up of granulation and fibrous tissue. The treatment of pseudocyst is directed by its symptoms. If the symptoms are not present, it is unnecessary to treat the cyst.
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Cystic Neoplasms: This include tumors such as mucinous cystadenoma, intraductal papillary mucinous neoplasm (IPMN), and papillary cystic neoplasm.
Pancreatic Duct Strictures: A common condition associated with benign and malignant causes. The benign causes of the strictures include trauma, recurrent acute pancreatitis, chronic pancreatitis, surgical complications, and pseudocysts. The symptoms include persistent abdominal pain, exocrine insufficiency, and chronic pancreatitis. The treatment of strictures depends on their nature, whether benign or malignant. Asymptomatic pancreatic strictures can be left untreated.
Pancreatic Perforations and Leakage: Any leakage or damage in the pancreatic duct due to infection or stent placement can lead to further complications such as abdominal pain, nausea, indigestion, and vomiting.
Conclusion:
Pancreatobiliary diseases are conditions that affect the pancreas and biliary duct. These conditions can cause inflammation, infection, and blockages in the organs due to the presence of gallstones. The conditions associated with the pancreas and bile duct are pancreatitis, gallstone accumulation, strictures, and benign and malignant cysts and tumors. The treatment of these conditions depends on their severity and nature.
