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Hepato-Pancreato-Biliary Insights

Hepatobiliary-Biliary disorders

What are Hepato-pancreato-biliary (HPB) Disorders? 

HPB disorders affect the **liver**, **pancreas**, and **bile ducts**. These conditions require specialized care and expertise. A safe, patient-centred surgery for both cancers and benign conditions, ensures the best outcomes.

Hepato-Pancreato-Biliary Tumors

 Liver Cancer

Primary Liver Tumor

These start in the liver. The most common type is “Hepatocellular Cancer (HCC)”. Risk factors include Alcohol use, diabetes, hepatitis B or C, and obesity. Symptoms are often vague, so diagnosis usually happens during scans.

Treatment Options:

• Liver transplant
• Surgery
• Therapies like TACE (Transarterial Chemoembolization)
• TARE (Transarterial Radioembolization), and
• Ablation
• Medicines like Sorafenib or Lenvatinib may also be used
• Immunotherapy

Secondary Liver Tumors

These spread from other parts of the body (e.g., colon, pancreas). Treatment depends on the origin of the cancer. For example, tumor arising in colon and/or rectum often spread to liver. Since the liver involvement is sequentially next from colon, treatment at this stage guarantees excellent outcomes. These are often treated with chemotherapy and surgery, leading to long survival. However, tumor arising in pancreas do not sequentially involve liver but represent simultaneous involvement in other parts of the body and hence have very poor outcome. You should consult your doctor and discuss on best available treatment course in such cases.

Neuroendocrine Tumours

 These are slow-growing and treatable with surgery or other methods, often with good outcomes. Their slow rate of increase in size, make them amenable for removal through surgery even if diagnosed at late stages. Sometimes, complete removal of tumor is also not necessary unlike other cancers.

Bile Duct Cancer (Cholangiocarcinoma)

 **Symptoms**:

Jaundice (yellow skin/eyes), dark urine, pale stools, and itching

If you notice yellow discoloration of eye or skin, change in colour of urine, stool along with itching, most probably you are having obstruction in the bile flow from the liver due to the growth of the tumour.  

-Diagnosis: CT or MRI scans

                             Discuss with your doctor about the findings of the CT or MRI scans. Extent and complexity of surgery is often dictated by these findings. Sometimes your doctor may be in suspicion of further extent of tumour and may suggest doing laparoscopic survey of the abdomen before proceeding to major surgery. Discuss possible course of action after laparoscopic survey of the abdomen.

Treatment: Surgery is the best option if the cancer is localized. For lower bile duct cancers, a **pancreaticoduodenectomy** (removal of part of the pancreas and intestine) is performed. Hilar cholangiocarcinoma (near the liver) requires complex liver surgery.

              These surgeries should ideally be performed by well trained HPB surgeons. Once the diagnosis is established one should not waste time. Also, diagnosis is generally straightforward and even USG can give valuable information on time. Patient should immediately seek the advice of expert as prolongation of jaundice might require additional procedure, increase the complexity of surgery and prolong the recovery considerably.

Gallbladder Cancer

Symptoms: Jaundice, weight loss, and abdominal pain.

Common in India: If caught early, surgery can remove the gallbladder and part of the liver. Advanced cases may require chemotherapy.

                             Gall bladder cancers are notorious for poor outcomes and survival may be very limited if diagnosed late. USG findings indicating any abnormality in the gall bladder could be a potential tumour growth in its early stages when the result of treatment is the best. Seek advice of an HPB/Gastrointestinal surgeon for accurate guidance and management.

Pancreatic Cancer

Symptoms:  Jaundice (if the tumor is in the head of the pancreas), weight loss, and fatigue.

Diagnosis: CT scan

Treatment: Surgery (e.g., **pancreaticoduodenectomy** for head tumors) or chemotherapy. Advanced cases may require palliative care (concerns only with resolution of symptoms and comfort but have no impact on survival).

Paediatric Hepatobiliary Disorders

Biliary Atresia

What is it? A condition in infants where bile ducts are blocked, leading to liver damage.

Symptoms: Jaundice, dark urine, pale stools, and weight loss.

Treatment: **Kasai procedure** (surgery) and often a liver transplant later.

Choledochal Cyst

–What is it? A congenital condition where bile ducts are abnormally enlarged.

–Symptoms: Abdominal pain, jaundice, and fever.

–Treatment: Surgery to remove and reconstruct the bile ducts.

Hepatoblastoma and Embryonal Sarcoma

What are they? Rare liver cancers in children.

Symptom: Abdominal lump, pain, and weight loss.

Treatment: Chemotherapy, surgery, or liver transplant.

Pancreatic Disorders

Acute Pancreatitis

What is it? Sudden inflammation of the pancreas.

Symptoms: Severe abdominal pain.

Causes: Gallstones or heavy alcohol use.

Treatment: ICU care, drainage, or surgery if complications arise.

          Acute pancreatitis is a sudden, serious and life-threatening condition if it is severe. Fortunately, most episodes are mild and self-limited. Pancreas is an organ which lies behind the stomach and concerns mainly with digestion of fat and proteins in the diet. Once injured, it spills these digestive enzymes and start eating normal fats and tissues releasing myriads of toxins which affects our vitals organs. Patients generally require ICU and prolonged care if it is severe pancreatitis.

Chronic Pancreatitis

What is it?  Long-term inflammation of the pancreas.

Symptoms: Pain, diabetes, and digestive issues.

Treatment: Pain management, enzymes, or surgery if complications occur.

  Prolonged exposure to the risk factors like alcohol, smoking apart from genetic predisposition causes chronic (continuous and long-standing damage to the Pancreas) pancreatitis. Digestion of fat suffers the most as the entire organ is exhausted and no more able to provide necessary enzymes for this purpose. Stones might form and could be the cause of gnawing pain which disturbs daily life. Such patients often need surgery for amelioration of pain and improved quality of life.

Biliary Disorders

Gallstones

Symptoms: Pain in the upper right abdomen, especially after fatty meals.

Treatment: **Laparoscopic cholecystectomy** (gallbladder removal) for symptomatic cases.

        If you have suffered symptoms due to stones in the gall bladder, you should strongly consider surgical removal of gall bladder. The stones in the gall bladder are generally due to the diseases of the gall bladder and bile. Unlike kidney stones where stone removal is the priority, herein removal of gall bladder is necessary. Now a days, gall bladder removal could be performed with keyhole surgeries in almost all cases. No long-term impact of removal of gall bladder on our digestive has been seen and such removal is completely safe. Please note that, one should avoid undergoing surgery if there are no symptoms or consult and discuss with your doctor of its necessity. Though it is one of the most performed operations (sometimes performed even as day care surgery) complications although rare could be life threatening and prolonged suffering with requirement of re surgery.

Biliary Strictures:

What is it? Narrowing of the bile ducts due to tumors, infections, or surgery.

Treatment: Medicines, endoscopic therapy, or surgery.

Conclusion:

HPB disorders require specialized care, but with the right treatment, management.