Specific Diagnoses and Management Principles of the Hepatobiliary and Pancreatic Diseases

Abstract

Hepatobiliary and pancreatic diseases are among common illnesses which cause major morbidity and mortality in the middle-aged and elderly patients and some specific subpopulations. Some geographic predispositions also exist for some diseases. For example, pain, fever, jaundice, and hepatomegaly can be noted in hydatic cyst disease which may cause allergic reaction and portal hypertension in the Southeast Europe and the Middle East. Of note, hepatobiliary and pancreatic diseases are commonly confused with each other, which may complicate diagnostic and therapeutic processes. A patient with biliary stones may be asymptomatic or suffer from acute or chronic cholecystitis, biliary colic, obstructive jaundice, cholangitis, mucocele, empyema, acute pancreatitis, gallstone ileus, and carcinoma. Cholecystitis and cholangitis are among diseases with high morbidity especially in the elderly and thus need to be ruled out in any patient with abdominal pain evaluated in acute and primary care setting. Some diagnostic clues are extremely helpful, such as Charcot triad which suggest severe cholecystitis (right upper quadrant AP, jaundice and fever) or cholangitis when complicated by altered mental status and hemodynamic instability. Acute pancreatitis refers to acute response to injury of the pancreas is referred to. Chronic pancreatitis, on the contrary, results from permanent damage to the endocrine and exocrine functions of the gland. Ultrasound, computed tomography and magnetic resonance imaging are among invaluable tools in diagnosing these diseases, together with specific laboratory adjuncts such as serum lipase for pancreatitis and bilirubin for obstructive jaundice. Definitive treatment encompasses surgical procedures, mostly in patients with acute abdomen due to gallstones or pancreatic necrosis.