Biliary obstruction is a blockage of the bile ducts. A “duct” is a tube that carries specific bodily fluids.
The bile ducts carry bile from the liver and gallbladder through the pancreas to the duodenum, which is a part of the small intestine. Bile is a dark-green fluid secreted by the liver to digest fats, and it’s stored in the gallbladder.
After you eat, the gallbladder releases bile to help in digestion and fat absorption. Bile also helps clear the liver of waste products.
Obstruction of any of these bile ducts is referred to as a biliary obstruction. Many of the conditions related to biliary obstructions can be treated successfully. However, if the blockage remains untreated for a long time, it can lead to life threatening diseases of the liver.
You have several types of bile ducts. The
- Intrahepatic ducts. Intrahepatic ducts are a system of smaller tubes within the liver that collect and transport bile to the extrahepatic ducts.
- 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 cystic duct, or 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:
The following are some of the most common causes of biliary obstruction:
- gallstones, which are the most common cause
- inflammation of the bile ducts
- a biliary stricture, which is an abnormal narrowing of the duct
- enlarged lymph nodes
- an injury related to gallbladder or liver surgery
- tumors that have reached the liver, gallbladder, pancreas, or bile ducts
- infections, including hepatitis
- cirrhosis, or scarring of the liver
- severe liver damage
- choledochal cyst (present in infants at birth)
The risk factors for biliary obstruction usually depend on the cause of the obstruction. Some risk factors include:
- a history of gallstones
- Caroli disease, a rare disorder that causes bile ducts in the liver to widen, which can cause stones to form
- chronic pancreatitis
- pancreatic cancer
- an injury to the right part of the abdomen
- rapid weight loss
- conditions related to the breakdown of red blood cells, such as sickle cell anemia
Some conditions that can cause biliary obstruction have genetic connections, while others do not.
For example, bile duct cancer
If a healthcare professional believes you may be dealing with a biliary obstruction, they will most likely ask if anyone in your family has a history of gallstones or certain cancers. Knowing your family health history can be very helpful in this situation, as well as any situation where you’re dealing with symptoms that don’t seem to have an obvious cause.
Various tests are available to check for a biliary obstruction. Based on the cause of the obstruction, your doctor may recommend one or more of the following tests.
An ultrasound is usually the first test performed on anyone who is suspected of dealing with biliary obstruction due to gallstones. It allows your doctor to see the gallstones easily.
- increased level of white blood cells, which can signal inflammation
- an increased level of conjugated bilirubin, which is a waste product of the liver
- an increased level of liver enzymes
- an increased level of alkaline phosphatase
Any of these may indicate a loss of bile flow.
Biliary radionuclide scan (HIDA scan)
A cholangiography is an X-ray of the bile ducts.
An MRI can provide detailed pictures of the liver, gallbladder, pancreas, and bile ducts.
Magnetic resonance cholangiopancreatography (MRCP)
Magnetic resonance cholangiopancreatography (MRCP) is used for the diagnosis of biliary obstructions and pancreatic disease.
Endoscopic retrograde cholangiopancreatography (ERCP)
An endoscopic retrograde cholangiopancreatography (ERCP) involves the use of an endoscope and X-ray. It’s both a diagnostic and therapeutic tool. It allows your surgeon to see the bile ducts, and it’s also used in treatment. This tool is particularly helpful because your doctor can use it to remove stones and take biopsy samples if necessary.
Treatment is aimed at correcting the underlying cause, and the primary goal of medical or surgical treatment is to alleviate the blockage. Some of the treatment options for a biliary obstruction include a cholecystectomy and an ERCP.
If you’ve been diagnosed with gallstones, an 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. This method is often used in cases where obstruction is caused by a tumor.
A cholecystectomy, which is the removal of the gallbladder, is another very effective treatment for gallstones.
Other therapies include the removal or treatment of tumors and medication to eradicate parasites.
Without treatment, biliary duct obstructions can be life threatening. Possible complications that can arise without treatment include:
- chronic liver disease
- biliary cirrhosis
Contact your doctor right away if you develop jaundice or notice a change in color of your stool or urine.
Here are a few changes you can make to lower your chances of developing a biliary obstruction: