Hepatobiliary Disease

Hepatobiliary disease includes a range of disorders affecting the liver, gallbladder, and bile ducts—organs that work together to help digest food, remove waste, and keep your body healthy. These conditions can vary from minor problems to serious diseases that may require lifelong care.

Table of contents

• What is Hepatobiliary Disease?
• The Organs of the Hepatobiliary System
• Risk Factors
• Types of Hepatobiliary Disease

What is Hepatobiliary Disease?

Hepatobiliary disease is any disorder of the hepatobiliary system (the group of organs that includes the liver, gallbladder, and bile ducts) that impairs its normal function^[1][2]. These diseases can range from minor infections or scarring to serious conditions such as cancer^[2].

Hepatobiliary disease includes a diverse group of conditions caused by viral, bacterial, and parasitic infections, neoplasia (abnormal cell growth), toxic chemicals, alcohol consumption, poor nutrition, metabolic disorders (problems with how the body uses food and energy), and heart failure^[1][6]. In the United States, the two most common diseases of the liver are viral hepatitis and cirrhosis, while the most common chronic disease of the biliary system is cholelithiasis (gallstones)^[1].

The Organs of the Hepatobiliary System

• Liver
• Gallbladder
• Bile ducts

The liver is one of the largest organs of the human body and is situated in the upper right portion of your abdomen^[2][3]. It performs some of the body’s vital functions including:

• Production of bile juice
• Storing sugars in the form of glycogen (a stored form of energy)
• Purifying blood from harmful substances
• Making proteins that help in blood clotting

The gallbladder is a small organ below the liver that stores a fluid called bile, which is necessary for fat digestion^[2][3]. The bile duct carries bile from the gallbladder to the small intestine, where it helps to break down and digest food^[2][6].

Risk Factors

The common risk factors that can cause hepatobiliary disease include^[2][3]:

• Advanced age
• Stress
• Smoking
• Diabetes
• Obesity
• Hormonal pills
• Inflammatory bowel disease
• Autoimmune diseases
• Excessive alcohol consumption
• Exposure to chemicals or toxins
• Exposure to infected blood (from a person with hepatitis) by the sharing of contaminated needles, razors, or blood transfusions
• Genetic diseases such as Wilson’s disease, hemochromatosis (a genetic condition causing high iron levels), and Alpha-1 antitrypsin deficiency

Types of Hepatobiliary Disease

Choledocholithiasis

Choledocholithiasis is the presence of gallstones in the bile duct, causing obstruction^[2][3]. Gallstones can occur in the gallbladder and migrate to the bile duct, or they can form in the bile duct itself. Gallstones are usually composed of cholesterol or bile pigments. Lesser-known gallstones are made up of cholesterol and calcium salts. Cholesterol stones or pigment stones may be formed due to excess secretion of bilirubin (an orange-yellow pigment) or cholesterol, low secretion of bile salts, or the presence of an infection^[2][3].

Primary Sclerosing Cholangitis

Primary sclerosing cholangitis is a liver disease that causes narrowing of the bile duct^[2][3]. As the disease slowly progresses, bile builds up in the liver, damaging the cells. Scar tissue can spread throughout the liver, causing cirrhosis (severe scarring) and liver failure. The cause of primary sclerosing cholangitis is unknown but is associated with inflammatory diseases such as inflammatory bowel disease, ulcerative colitis, and Crohn’s disease^[2][3].

Liver Cirrhosis

Cirrhosis of the liver is a chronic and usually relentlessly progressive disease characterized by loss of normal liver structure, fibrosis (scarring), impairment of the blood supply, and regeneration of disorganized liver structures^[1]. These changes eventually result in liver failure. In 1983, cirrhosis was the cause of 28,000 deaths, making it the ninth leading cause of death in the United States^[1].

Cirrhosis is severe scarring of the liver and poor liver function due to excessive exposure to alcohol or due to a viral infection^[2][3]. According to the National Institute of Health, people who regularly consume alcohol for more than 10 years can develop cirrhosis. Excess scar tissue is formed when your liver is exposed to damaging factors for a long period of time, making it difficult to repair itself. A cirrhotic liver appears hard and shrunken^[2][3].

Cirrhosis may be caused by viral hepatitis, hemochromatosis, obstructive lesions of the biliary system, congestive heart failure, and chronic alcoholism^[1]. Estimates of the proportion of deaths from cirrhosis due to alcohol consumption in the United States range from 50 to 95 percent^[1].

Autoimmune Liver Diseases

The immune system protects the body by attacking and destroying foreign and harmful substances. However, in autoimmune liver diseases, the body’s immune system attacks its own liver (liver cells and bile duct cells), causing inflammation and liver damage^[2][3]. For example, autoimmune hepatitis. Untreated autoimmune liver disease can progress into cirrhosis, liver failure, and cancer^[2][3].

Fatty Liver Disease

Fatty liver disease is a condition caused by excess fat buildup in the liver cells. It is most common in middle-aged people. Fatty liver disease is also called hepatic steatosis^[2][3]. Fatty liver is of two types:

• Non-alcoholic Fatty Liver: Buildup of fat in the liver is not associated with the consumption of alcohol.
• Alcoholic Fatty Liver: Buildup of fat in the liver is associated with excess alcohol consumption.

Simple fatty liver is an early stage of fatty liver disease and often not serious. Nonalcoholic Steatohepatitis (NASH) is an advanced stage that causes inflammation of the liver and damage to liver cells causing liver cirrhosis, liver cancer, ascites (buildup of fluid in the belly), and ultimately, liver failure^[2][3].

Biliary Dyskinesia

Biliary dyskinesia or gallbladder dyskinesia is a motility disorder of the biliary system in which the bile does not drain out well from the gallbladder^[2][3]. Bile is a dark green to yellowish-brown fluid, secreted by the liver and stored in the gallbladder.