Pancreaticobiliary disease

What is pancreaticobiliary disease?

Pancreaticobiliary disease is an umbrella term for conditions affecting your pancreas, gallbladder and bile ducts, the organs and tubes that produce and carry the digestive juices and enzymes your body needs to break down food. These conditions range from gallstones and infections to inflammation and cancer.

What are the symptoms of pancreaticobiliary disease?

Symptoms depend on which organ is affected but often overlap. You might notice:

• Abdominal pain, tenderness or swelling
• Nausea and vomiting
• Fever, and sometimes chills
• Loss of appetite and unintended weight loss
• Diarrhoea, excess wind, or pale, foul-smelling stools

If your bile ducts or gallbladder are affected, you may also develop jaundice (yellowing of your skin or eyes), along with dark urine, clay-coloured stools, and itchy skin.

What are the causes of pancreaticobiliary disease and who is at risk?

Causes vary depending on which organ is affected and the specific condition, but include:

• Gallstones, which can block the flow of bile and are a common cause of gallbladder and bile duct problems
• Long-term heavy alcohol use
• Inherited conditions, such as cystic fibrosis or hereditary pancreatitis
• Infection
• Tumours, which can block or narrow the bile ducts or pancreas
• Congenital abnormalities of the pancreas, such as pancreas divisum, where the pancreas doesn't develop in the usual way before birth

Are there different types of pancreaticobiliary disease?

Pancreaticobiliary disease covers conditions in three connected areas:

• Pancreas disorders: acute and chronic pancreatitis (inflammation of the pancreas), pancreatic tumours, and pancreatic cysts
• Gallbladder disorders: gallstones (cholelithiasis), inflammation of the gallbladder (cholecystitis), infection, and blockage
• Bile duct disorders: stones in the bile duct (choledocholithiasis), narrowing or blockage (strictures), infection (cholangitis), cysts, and bile duct cancer (cholangiocarcinoma)

How is pancreaticobiliary disease diagnosed?

Your doctor will examine you and ask about your symptoms, then may arrange:

• Blood tests, to check for abnormal enzyme levels and other markers
• A CT or MRI scan, to get detailed images of your pancreas, gallbladder and bile ducts
• Magnetic resonance cholangiopancreatography (MRCP), a type of MRI scan that looks specifically at your bile and pancreatic ducts
• Endoscopic ultrasound (EUS), where a small probe on a thin tube is passed down your throat to get close-up images
• Endoscopic retrograde cholangiopancreatography (ERCP), a procedure that combines endoscopy and X-rays, and can treat some problems, such as removing stones, at the same time as diagnosing them
• A biopsy (fine needle aspiration) or genetic testing, in some cases

How is pancreaticobiliary disease treated?

Non-surgical treatment

Treatment depends on your specific diagnosis, but non-surgical options can include:

• Medication, to manage pain, infection or the underlying cause
• Endoscopic retrograde cholangiopancreatography (ERCP), which can remove stones or place a stent to relieve a blockage, without the need for surgery
• Endoscopic ultrasound (EUS)-guided procedures, for some cysts or blockages

Surgical treatment

Surgery may be recommended for some conditions, such as removing the gallbladder if gallstones keep causing problems, or removing a tumour, cyst or damaged section of the bile duct or pancreas. Your specialist will discuss which approach is right for your situation.

When should I see a doctor?

See your doctor if you have ongoing abdominal pain, unexplained weight loss, or any change in your stools or urine. Jaundice, fever or severe abdominal pain need prompt medical assessment, as they can be a sign of infection, blockage or a more serious underlying problem.