Pancreatic & Biliary Diseases

Overview

The pancreas, bile ducts and why they matter

The biliary system carries bile from the liver and gallbladder into the small intestine. The pancreas sits alongside it and produces digestive enzymes and insulin. Because these structures are small, deeply placed and connected, disease in one rapidly affects the other — a stone in the bile duct can block the pancreas, and inflammation of the pancreas can narrow the bile duct.

These conditions also tend to present in a similar way: upper abdominal pain radiating to the back, nausea, jaundice, fever, or abnormal liver tests. Distinguishing between them needs the right imaging and, frequently, endoscopic treatment.

Conditions we assess and treat

• Gallstones and biliary colic
• Common bile duct stones
• Obstructive jaundice
• Acute pancreatitis
• Chronic pancreatitis
• Pancreatic pseudocyst
• Pancreatic cysts and incidental lesions
• Bile duct strictures
• Bile leaks after gallbladder surgery
• Cholangitis (bile duct infection)
• Suspected pancreatic or bile duct tumours
• Sphincter of Oddi dysfunction

How these conditions are investigated

• Blood tests — liver function (especially bilirubin, ALP and GGT), amylase and lipase, complete blood count and inflammatory markers.
• Abdominal ultrasound — the first test for gallstones and dilated bile ducts.
• CT scan — for pancreatitis severity and for suspected masses.
• MRI / MRCP — detailed non-invasive imaging of the bile and pancreatic ducts.
• Endoscopic ultrasound (EUS) — high-resolution imaging from inside the gut, and tissue sampling where a mass or cyst is found.
• ERCP — which is both diagnostic and therapeutic: stones can be removed, strictures dilated and stents placed.

Because several of these tests answer different questions, the sequence matters. Doing them in the right order usually avoids duplication and shortens the time to treatment.

When ERCP is the right answer

ERCP is no longer used simply to look at the bile ducts — MRCP and EUS do that non-invasively and more safely. ERCP is now primarily a treatment. It is the appropriate choice when a stone needs to be removed from the bile duct, when jaundice is caused by an obstruction that must be relieved, when a stent is required, or when a bile leak needs to be sealed. Full details are on the ERCP page.

Acute pancreatitis: why early care matters

Acute pancreatitis is inflammation of the pancreas that usually presents with severe upper abdominal pain radiating to the back, often with vomiting. Most cases are caused by gallstones or alcohol. The majority settle with supportive treatment — fluids, pain control, early nutrition — but a proportion become severe, and complications such as pancreatic necrosis, infection or organ dysfunction develop over the first 48–72 hours.

The practical implications are straightforward: pancreatitis should be assessed and monitored in hospital rather than managed at home, the cause should be established (because a gallbladder stone that caused one attack can cause another), and the gallbladder should generally be dealt with during the same admission or soon afterwards to prevent recurrence.

Pancreatic cysts and incidental findings

Pancreatic cysts are increasingly found by chance on scans done for other reasons. Most are harmless, but a minority have the potential to become significant over years. The key question is which type of cyst it is, and whether it needs surveillance or intervention. EUS is particularly useful here, because it can examine the cyst wall closely and sample cyst fluid when required. If a cyst is found in your scan, the usual plan is structured follow-up rather than immediate action.