A biliary obstruction is a blockage of the bile ducts. The bile ducts carry bile from the liver and gallbladder through the pancreas to the small intestine (the duodenum). Bile is a dark-green or yellowish-brown fluid secreted by the liver to digest fats. Much of the bile is released directly into the small intestine, but what remains is stored in the gallbladder. After you eat, the gallbladder releases bile to help in digestion and fat absorption. Bile also helps rid the liver of waste products.
Any kind of obstruction of any of these ducts is referred to as a biliary obstruction. They are quite common too, and affect five out of every 1,000 people in the United States. Many of the conditions related to biliary obstructions can be treated successfully. However, if the blockage remains untreated for a long period of time, it can lead to life-threatening diseases of the liver
There are several types of bile ducts at work in your body. The two types in the liver are intrahepatic and extrahepatic ducts.
Intrahepatic ducts are a system of smaller tubes that collect and transport bile to the extrahepatic ducts. The extrahepatic ducts begin as two parts, one on the right of the liver and the other on the left. As they descend from the liver, they unite to form the common hepatic duct. This runs directly toward the small intestine.
The biliary duct (the duct from the gallbladder) also opens into the common hepatic duct. The bile duct from this point onward is known as the common bile duct or choledochus. Before emptying into the small intestine the common bile duct passes through the pancreas.
A biliary obstruction may be caused by a number of factors involving the bile ducts, liver, gallbladder, pancreas, and the small intestine. The following are some of the most common causes:
- gallstones, responsible for majority of cases
- inflammation of bile ducts
- biliary strictures (abnormal narrowing of the ducts)
- enlarged lymph nodes
- injury related to gallbladder or liver surgery
- tumors of bile ducts
- tumors of pancreas
- other tumors which have reached the liver, gallbladder, pancreas, or bile ducts
- infections, including hepatitis
- liver cirrhosis (liver scarring, severe liver damage)
The risk factors for biliary obstruction usually depend on the cause of the obstruction. The majority of the cases are a result of gallstones, making women more vulnerable to developing a biliary obstruction. Other risk factors include:
- a history of gallstones
- chronic pancreatitis
- history of tumors in the right part of the abdomen
- injury to the right part of the abdomen
- rapid weight loss
The symptoms may be a result of the underlying condition (the cause of the obstruction), and therefore can vary. Patients usually complain of the following symptoms:
- light-colored stools
- dark urine
- yellowish skin and/or eyes (jaundice)
- pain in upper right side of abdomen
- weight loss
A variety of tests are available for the patient with possible biliary obstruction. These include:
- blood test: provides a complete blood count (CBC) and liver function tests. Blood tests can usually rule out certain conditions, such as cholecystitis (inflammation of the gallbladder); cholangitis (infection of the common bile duct); and an increased level of conjugated bilirubin (waste product of the liver), liver enzymes, and alkaline phosphatase. Any of these may indicate a loss of bile flow.
- ultrasonography: usually the first investigation performed on anyone suspected of a biliary obstruction. Allows for easy visualization of gallstones.
- biliary radionuclide scanning (HIDA scan): uses radioactive material to provides valuable information about the gallbladder and any possible obstructions.
- computed tomography (CT scan): combines multiple, finely detailed X-rays. percutaneous transhepatic cholangiography: an X-ray of the bile ducts.
- magnetic resonance imaging (MRI): provides detailed pictures of the liver, gallbladder, pancreas, and bile ducts.
- magnetic resonance cholangiopancreatography (MRCP): used for the diagnosis of biliary obstructions and pancreatic disease.
- endoscopic retrograde cholangiopancreatography (ERCP): utilizes an endoscope and X-ray. It is both a diagnostic and therapeutic tool. Apart from allowing your surgeon to see the bile ducts, it is also used in treatment. This tool is particularly helpful as it can be used to remove stones. Also used to obtain biopsies in cases involving tumors.
Treatment depends is aimed at correcting the underlying cause. The primary objective of medical or surgical treatment is to alleviate the blockage. Some of the treatment options may include:
- Cholecystectomy: removal of the gallbladder if there are gallstones
- ERCP: may be sufficient to remove small stones from the common bile duct or to place a stent inside the duct to restore bile flow
Here are a few lifestyle changes you can make to lower your chances of developing a biliary obstruction.
- increase the fiber in your diet
- decrease your consumption of sugar and saturated fats that can cause gallstones
- if you are overweight, gradually get your weight into a “healthy” range for your sex, age, and height