Diseases of Liver, Gallbladder and Pancreas

In the following, “liver, gallbladder, and pancreas (pancreas)” describes diseases that are assigned to this category according to ICD-10 (K70-K77, K80-K87, K90-K93). The ICD-10 is used for the International Statistical Classification of Diseases and Related Health Problems and is recognized worldwide.

Liver, gallbladder, and pancreas (pancreas)

The liver (Hepar) is the most important metabolic organ in humans and, as the largest digestive gland, is part of the digestive system. The gallbladder (vesica fellea or biliaris, Latin vesica “bladder” and fellis or bilis “bile“) serves as a reservoir for bile produced in the liver. Through the bile ducts, the bile concentrated in the gallbladder is directed into the small intestine, where it serves mainly for fat digestion and absorption. The pancreas is of great importance for digestion and carbohydrate metabolism.

Anatomy

LiverThe liver of an adult weighs 1,500 to 1,800 g. It receives about 30% of the blood flow and consumes about 20% of the total body oxygen.The liver is located in the right upper abdomen, below the diaphragm. It is dark brown, soft-elastic, and can be divided into four lobes, the lobi: two large lobes – right and left lobes of the liver – and two small lobes.On the lower side of the liver is the hepatic orifice. This is where the hepatic artery (arteria hepatica) and portal vein (vena portae) enter. The hepatic artery transports oxygenated blood from the heart to the liver and the portal vein transports deoxygenated blood from the abdominal organs.Attached to the lower surface of the liver is the gallbladder in connective tissue. Gallbladder, bile ducts The pear-shaped gallbladder is about 8 cm long and holds 30-70 ml. Its wall is expandable. The liver is traversed by many small bile ducts, which ultimately join and flow into two bile ducts – right ductus hepaticus and left ductus hepaticus. These two bile ducts join at the hepatic orifice to form the ductus hepaticus communis, a very short bile duct. The bile duct coming from the gallbladder (ductus cysticus), which transports the thickened bile, opens into it. The further section is called the ductus choledochus (large bile duct or common bile duct). This runs to the pancreas, crosses its head, and joins with the pancreatic excretory duct to form the ductus pancreaticus, which then leads to the duodenum (duodenum; first part of the small intestine). In the bile duct system, mechanical and chemical defense systems ensure that bacteria cannot colonize and cause infections. For example, the sphincter Oddi (sphincter muscle at the mouth of the bile duct in the duodenum/duodenum) closes the ductus choledochus (common bile duct) against the intestinal lumen. The permanent flow of bile prevents the ascending (“ascending”) of germs from the duodenum. The bile itself is sterile. The bile itself or its components (bile acids/bile salts) have an antibiotic effect. PancreasThe pancreas is located transversely in the upper abdomen. It is a glandular organ. In an adult it is about 14-18 cm long and weighs 60-100 g. Divided, the pancreas is divided into three sections:

  • Pancreatic head (caput pancreatis) – thickest part of the pancreas.
  • Pancreatic body (corpus pancreatis)
  • Pancreatic tail (cauda pancreatis)

The pancreas has an excretory duct, the ductus pancreaticus, which opens into the duodenum.

Physiology

LiverOnce nutrients have been absorbed in the small intestine and released into the blood, most of them first reach the liver via the portal vein. There, they are utilized, metabolized, broken down, or stored as needed.Furthermore, the liver can keep blood glucose (blood sugar) levels constant regardless of food intake (gluconeogenesis). Functions of the liver:

  • Digestive gland (production of bile) – daily, the liver produces more than half a liter of bile.
  • Breakdown and excretion of metabolic products
  • Detoxification of foreign substances – the liver is the main detoxification organ: e.g., it converts toxic ammonia into harmless urea and breaks down alcohol
  • Production of vital proteins (proteins) – albumin, antithrombin, blood clotting factors, hormones, plasminogen, transferrin, etc.
  • Involved in all major metabolic processes (carbohydrate, fat and protein metabolism).
  • Synthesis of:
    • Cholesterol and bile acids
    • Fats and lipoproteins – VLDL, triglycerides and others

      • .

  • Nutrient storage – it stores glucose in the form of glycogen and fat in the form of lipoproteins.
  • Vital substance stores (vitamin B12 and the trace elements iron, copper, manganese and zinc – bound to transport proteins).

Gallbladder, bile ductsThe gallbladder serves to store and thicken the bile juice (thickening to about 10% of the initial volume; 30-80 ml of bile), which is produced in the liver. From the gallbladder, bile passes in portions under contraction into the duodenum (duodenum; first section of the small intestine), where it is involved in fat digestion and absorption. Bile is a yellow to brownish liquid. The color is produced by the bile pigment bilirubin. Bile consists of bile acids, lecithin, bilirubin, cholesterol, water, and sodium and chloride. Cholesterol is present dissolved in the bile. If the composition of the bile changes, cholesterol can precipitate. Cholesterol stones are formed. They are the most common form of gallstones. PancreasThe pancreas (pancreas) has two important functions: an exocrine function and an endocrine function.

  • Exocrine function – amount and composition of pancreatic secretions depend on the type of food ingested; up to 1.5 liters of secretions can be produced daily
    • Synthesis (formation) of various digestive enzymes for carbohydrate, protein, and fat cleavage, such as trypsinogen, amylase, and lipase; these are then released into the duodenum
  • Endocrine function – about 5% of the cells are insular and are called islets of Langerhans.
    • Synthesis of vital hormones – insulin and glucagon, which regulate carbohydrate balance; these hormones are released directly into the blood
      • Insulin regulates the uptake of glucose into body cells.
      • Glucagon increases blood glucose levels by stimulating gluconeogenesis (new glucose formation) and glucose release into the blood by the liver

Common diseases of the liver, gallbladder and pancreas

  • Cholelithiasis (gallstone disease) – about 10-15% of the adult population are gallstone carriers, with women more commonly affected; many gallstones do not cause discomfort, but if they become lodged, colic (aching pain) and inflammation may occur
  • Hepatitis (inflammation of the liver)
  • Hepatic insufficiency (dysfunction of the liver with partial or complete failure of its metabolic functions).
  • Liver metastases – metastases (daughter tumors) in the liver.
  • Hepatocellular carcinoma (liver cancer)
  • Liver cirrhosis (liver shrinkage) – irreversible (non-reversible) damage to the liver and a pronounced remodeling of liver tissue.
  • Pancreatitis (inflammation of the pancreas).
  • Pancreatic cancer (pancreatic cancer)
  • Primary sclerosing cholangitis – chronic inflammation of the extrahepatic and intrahepatic (located outside and inside the liver) bile ducts.
  • Steatosis hepatis (NAFL/non-alcoholic fatty liver) and alcoholic steatohepatitis (ASH).

The main risk factors for diseases of the liver, gallbladder and pancreas

Behavioral causes

  • Diet
    • High in carbohydrates (mono- and disaccharides/single and double sugars), high in fat, high in cholesterol, too much animal protein, low in fiber.
  • Pleasure food consumption
    • Regular alcohol consumption
    • Tobacco use
  • Drug use
  • Lack of exercise
  • Overweight
  • Increased waist circumference (abdominal girth; apple type).

Causes due to disease

  • Diabetes mellitus type 2
  • Hepatitis, viral hepatitis
  • Hyperlipidemias (lipid metabolism disorders).
  • Hypertension (high blood pressure)
  • Insulin resistance

Medication

Environmental pollution – intoxications (poisonings).

  • Carcinogens such as arsenic (latency period 15-20 years); chromium (VI) compounds.
  • Molds – aflatoxin B (mold product) and other mycotoxins (toxic substances formed by fungi).

Please note that the enumeration is only an excerpt of the possible risk factors. Other causes can be found under the respective disease.

The main diagnostic measures for diseases of the liver, gallbladder and pancreas

Laboratory diagnostics

Medical device diagnostics

  • Sonography (ultrasound examination) of the abdominal organs.
  • Cholecystography – contrast-enhanced radiographic method of visualizing the gallbladder and biliary system.
  • Liver scintigraphy – for the assessment of liver function.
  • Computed tomography (CT) – imaging method of radiological diagnostics.
  • Magnetic resonance imaging (MRI)
  • Endoscopic retrograde cholangiopancreatography (ERCP) – X-ray imaging of the biliary system and ductus pancreaticus, for detection of cholelithiasis (gallstones).

Which doctor will help you?

For diseases of the liver, gall bladder and pancreas, the first point of contact is the family doctor, who is usually a general practitioner or internist. Depending on the disease or severity, a presentation to a specialist, in this case the gastroenterologist, may be required.