hepatobiliary disease

Hepatobiliary Disease: A Complex Condition

Hepatobiliary disease refers to any disorder affecting the liver, gallbladder, or bile ducts [6]. This condition can range from minor infections to serious conditions that require surgical correction [5].

The hepatobiliary tract is a target for various tropical infections, such as malaria, typhoid, leptospirosis, strongyloidiasis, and invasive amoebiasis, which can cause multiorgan involvement [1]. In addition, chronic hepatitis and biliary ascariasis are significant causes of morbidity and mortality among residents in the tropics [2].

Hepatobiliary disease can be caused by infectious agents, such as viruses (e.g., hepatitis A), bacteria, and parasites. It can also result from neoplasia, toxic chemicals, alcohol consumption, poor nutrition, metabolic disorders, and cardiac failure [10]. The two predominant liver diseases in the United States are viral hepatitis and cirrhosis [10].

Symptoms of hepatobiliary disease may be vague, making it difficult to suspect hepatic disease until biochemical tests identify elevated liver enzyme activity or other evidence of hepatic dysfunction [14]. Common symptoms include jaundice, abdominal pain, and weight loss.

Types of Hepatobiliary Disorders

Hepatobiliary disorders can be congenital or acquired. They may affect the liver, gallbladder, or bile ducts and require surgical correction. Some common hepatobiliary disorders include:

• Alcoholic liver disease
• Autoimmune hepatitis
• Benign and malignant liver tumors
• Budd-Chiari syndrome
• Cholangiocarcinoma (bile duct cancer)
• Drug-induced liver injury
• Gallbladder disease
• Metabolic disorders

Prevalence and Impact

Hepatobiliary disease is a significant cause of morbidity and mortality worldwide. It can lead to serious complications, such as symptomatic cholelithiasis, gallstone pancreatitis, acute cholecystitis, chronic cholecystitis, choledocholithiasis, and ascending cholangitis [15].

In individuals with very low CD4+ counts (often less than 20 cells/µL), hepatobiliary disease is associated with significant liver dysfunction and may require special consideration in the evaluation of abnormalities in liver function [12].

Diagnosing hepatobiliary diseases, which affect the liver and bile ducts, can be a complex process involving various diagnostic tests. Here are some common tests used to diagnose these conditions:

Blood Tests

• Liver function blood tests: These tests measure the levels of certain proteins and enzymes in the blood, providing important information about liver health.
• Serum albumin test: This test measures the level of albumin (a protein) in the blood, which can indicate liver disease.
• Serum alkaline phosphatase test: This test measures the level of alkaline phosphatase (an enzyme) in the blood, which is found in many tissues, including the liver.

Imaging Tests

• Ultrasound: An ultrasound can show liver damage and gallbladder disease.
• CT scan and MRI: These imaging tests can also show liver damage and help diagnose conditions such as liver cancer.

Liver Biopsy

• A liver biopsy involves removing a tissue sample from the liver, which is then sent to a lab for testing. This test can provide a definitive diagnosis of liver disease.

Other Tests

• Liver function tests (LFTs): These blood tests measure the levels of certain enzymes and proteins in the blood, which can indicate liver damage.
• 5'-nucleotidase test: This test measures the level of 5'-nucleotidase, an enzyme made only in the liver. Elevated levels can indicate liver disease.

Diagnostic Accuracy

It's worth noting that while these tests can provide valuable information about hepatobiliary diseases, they may not always be accurate or definitive. Additional testing and evaluation by a healthcare professional are often necessary to confirm a diagnosis.

References:

• [2] Gurusamy KS, Giljaca V, Takwoingi Y, et al: Ultrasound versus liver function tests for diagnosis of common bile duct stones.
• [13] McIntosh DM, Penney HF: Gray-scale ultrasonography as a screening procedure in the detection of gallbladder disease. Radiology. 136(3):725-727, 1980. doi: 10.1148/radiology.136.3.7403554.
• [15] Liver diseases are common, and currently represent the 12th leading cause of death in the United States. However, numerous hepatic disorders exist, and differential diagnosis often is difficult. Moreover, because laboratory testing is routine, an abnormal serum transaminase or alkaline phosphatase i …

Treatment Options for Hepatobiliary Disease

Hepatobiliary disease encompasses a range of conditions affecting the liver and biliary system. While there is no cure for many of these diseases, various treatment options are available to manage symptoms, slow disease progression, and improve quality of life.

• Medications: Several medications can help alleviate symptoms and complications associated with hepatobiliary disease. For example:
  • Ursodeoxycholic acid (UDCA) is the main treatment for primary biliary cholangitis (PBC), helping to delay liver damage in most people.
  • Tofacitinib, a Janus kinase inhibitor, has been approved for treating inflammatory bowel diseases (IBD), including ulcerative colitis (UC).
• Liver Transplantation: In advanced cases of hepatobiliary disease, liver transplantation may be necessary to replace the damaged liver with a healthy one.
• Endoscopic Treatment: Endoscopic procedures can help treat biliary stenosis and other complications associated with hepatobiliary disease.

Emerging Therapies

Research is ongoing to develop new treatments for hepatobiliary diseases. Some emerging therapies include:

• Resmetirom: A medication approved for treating non-alcoholic steatohepatitis (NASH), which targets a protein in the liver and reduces liver fat, inflammation, and scarring.
• Clonidine and Spironolactone: A combination of medications that has shown promise in treating certain types of hepatobiliary disease.

Prevention Strategies

While there is no surefire way to prevent hepatobiliary diseases, some strategies can help reduce the risk:

• Healthy Lifestyle Choices: Maintaining a healthy weight, exercising regularly, and avoiding excessive alcohol consumption can help mitigate liver damage.
• Regular Check-ups: Regular health check-ups can help detect potential issues early on, allowing for prompt treatment.

References

1. [4] At the present time, caution should be exercised in prescribing drugs to patients with liver disease and the dose should be titrated to the clinical response.
2. [9] Ursodeoxycholic acid (UDCA) is the main treatment for PBC. It can help delay liver damage in most people, particularly if you start taking it in the early stages.
3. [10] Tofacitinib is an oral Janus kinase inhibitor and is the first drug of this class approved for the treatment of IBD, specifically UC since May 2018.
4. [13] Hepatobiliary disease includes a heterogeneous group of diseases of the liver and biliary system caused by viral, bacterial, and parasitic infections, neoplasia, toxic chemicals, alcohol consumption, poor nutrition, metabolic disorders, and cardiac failure.
5. [14] PSC management is directed against symptoms and complications and includes medical therapies for pruritus, endoscopic treatment of biliary stenosis and liver transplant for end-stage liver disease.