What is bile duct obstruction?
Bile duct obstruction refers to a blockage in the ducts or tubes that transport bile from the liver to the gall bladder and the small intestine.
Bile, a fluid released by the liver contains bile salts, cholesterol and bilirubin. Bile salts in the bile are useful in digesting fats. Bile is taken out from the liver and stored in the gall bladder, a process facilitated by tubes known as bile ducts. It is later released into the small intestine to aid digestion. A blockage of bile duct causes bile to accumulate in the liver, also increasing the levels of bilirubin in blood (manifesting as jaundice).
What are the causes of the disorder?
Bile duct obstruction could result from the following:
- Cysts in the common bile duct
- Inflammation of bile ducts
- Injury from gallbladder surgery
- Enlarged lymph nodes in porta hepatis
- Bile duct or pancreatic tumour; spread of tumour to the biliary system
- Infection that weakens the immune system
The risk of an obstructed bile duct is high in the following cases:
- History of gallstones, pancreatic cancer or chronic pancreatitis
- Recent abdominal injury or biliary surgery
What one needs to know about symptoms or signs?
Bile duct obstruction will show the following signs:
- Upper right abdominal pain
- Dark coloured urine
- Nausea, vomiting
- Pale coloured stools
Which specialist should be consulted in case of signs and symptoms?
A person should consult a doctor if s/he notices any of the above symptoms. S/he will then be referred to a gastroenterologist.
What are the screening tests and investigations done to confirm or rule out the disorder?
Diagnosing a bile duct obstruction is done through:
- Blood tests (These look for increased levels of bilirubin, liver enzymes and alkaline phosphatase)
- Abdominal ultrasound
- Abdominal CT scan
- Magnetic resonance cholangiopancreatography or MRCP
- Endoscopic retrograde cholangiopancreatography or ERCP
- Percutaneous transhepatic cholangiogram or PTCA
What treatment modalities are available for management of the disorder?
Treatment aims to remove the blockage of the bile duct.
- This is commonly carried out through an endoscopic procedure known as Endoscopic retrograde cholangiopancreatography or ERCP.
- Some cases require surgery to go past the blockage (bypass).
- Gall bladder may be removed in case gallstones are causing the bile duct blockage.
- Obstruction due to cancer requires widening of the duct. This may be carried out through Endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiogram (PTCA)
What are the known complications in management of the disorder?
Complications due to bile duct blockage include:
- A fatal infection and life threatening rise of bilirubin levels
- Chronic liver disease can result if the blockage is left untreated for a long time.
How can the disorder be prevented from happening or recurring?
It is advisable to know one’s risk factors towards developing a bile duct blockage, which can enable quick diagnosis and early treatment. Occurrence of blockage, however, cannot be prevented.
“Bile duct obstruction,” MedlinePlus, NLM,NIH, https://www.nlm.nih.gov/medlineplus/ency/article/000263.htm
“Bile Duct Obstruction,” NYtimes.com, https://www.nytimes.com/health/guides/disease/bile-duct-obstruction/overview.html
“Management of Bile Duct Problems Treatment Overview,” CPMC.org, California Pacific Medical Center, https://www.cpmc.org/advanced/liver/patients/topics/bileduct-profile.html
Image courtesy of [Ohmega1982] at FreeDigitalPhotos.net