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Bile duct obstruction

Biliary obstruction

 

Bile duct obstruction is a blockage in the tubes that carry bile from the liver to the gallbladder and small intestine.

Causes

 

Bile is a liquid released by the liver. It contains cholesterol, bile salts, and waste products such as bilirubin. Bile salts help your body break down (digest) fats. Bile passes out of the liver through the bile ducts and is stored in the gallbladder. After a meal, it is released into the small intestine.

When the bile ducts become blocked, bile builds up in the liver, and jaundice (yellow color of the skin) develops due to the increasing level of bilirubin in the blood.

The possible causes of a blocked bile duct include:

  • Cysts of the common bile duct
  • Enlarged lymph nodes in the porta hepatis
  • Gallstones
  • Inflammation of the bile ducts
  • Narrowing of the bile ducts from scarring
  • Injury from gallbladder surgery
  • Tumors of the bile ducts or pancreas
  • Tumors that have spread to the biliary system
  • Liver and bile duct worms (flukes)

The risk factors include:

  • History of gallstones, chronic pancreatitis, or pancreatic cancer
  • Injury to the abdominal area
  • Recent biliary surgery
  • Recent biliary cancer (such as bile duct cancer)

The blockage can also be caused by infections. This is more common in people with weakened immune systems.

 

Symptoms

 

Symptoms may include:

  • Abdominal pain in the upper right side
  • Dark urine
  • Fever
  • Itching
  • Jaundice (yellow skin color)
  • Nausea and vomiting
  • Pale-colored stools

 

Exams and Tests

 

Your health care provider will examine you and feel your belly.

The following blood test results could be due to a possible blockage:

  • Increased bilirubin level
  • Increased alkaline phosphatase level
  • Increased liver enzymes

The following tests may be used to investigate a possible blocked bile duct:

  • Abdominal ultrasound
  • Abdominal CT scan
  • Endoscopic retrograde cholangiopancreatography (ERCP)
  • Percutaneous transhepatic cholangiogram (PTCA)
  • Magnetic resonance cholangiopancreatography (MRCP)
  • Endoscopic ultrasound (EUS)

A blocked bile duct may also alter the results of the following tests:

  • Amylase blood test
  • Gallbladder radionuclide scan
  • Lipase blood test
  • Prothrombin time (PT)
  • Urine bilirubin

 

Treatment

 

The goal of treatment is to relieve the blockage. Stones may be removed using an endoscope during an ERCP.

In some cases, surgery is required to bypass the blockage. The gallbladder will usually be surgically removed if the blockage is caused by gallstones. Your provider may prescribe antibiotics if an infection is suspected.

If the blockage is caused by cancer, the duct may need to be widened. This procedure is called endoscopic or percutaneous (through the skin next to the liver) dilation. A tube may need to be placed to allow drainage.

 

Outlook (Prognosis)

 

If the blockage is not corrected, it can lead to life-threatening infection and a dangerous buildup of bilirubin.

If the blockage lasts a long time, chronic liver disease can result. Most obstructions can be treated with endoscopy or surgery. Obstructions caused by cancer often have a worse outcome.

 

Possible Complications

 

Left untreated, the possible complications include infections, sepsis, and liver disease, such as biliary cirrhosis.

 

When to Contact a Medical Professional

 

Call your provider if you notice a change in the color of your urine and stools or you develop jaundice.

 

Prevention

 

Be aware of any risk factors you have, so that you can get prompt diagnosis and treatment if a bile duct becomes blocked. The blockage itself may not be preventable.

 

 

References

Anstee QM, Jones DEJ. Liver and biliary tract disease. In: Walker BR, Colledge NR, Ralston SH, Perman ID, eds. Davidson's Principles and Practice of Medicine. 22nd ed. Philadelphia, PA: Elsevier; 2014:chap 23.

Fogel EL, Sherman S. Diseases of the gallbladder and bile ducts. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 155.

 
  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Endocrine glands

    Endocrine glands - illustration

    Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

    Endocrine glands

    illustration

  • Bile pathway

    Bile pathway - illustration

    The biliary system is comprised of the organs and duct system that create, transport, store and release bile into the duodenum for digestion. Includes the liver, gallbladder and bile ducts (named the cystic, hepatic, common, and pancreatic duct).

    Bile pathway

    illustration

  • Biliary obstruction - series

    Biliary obstruction - series

    Presentation

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Endocrine glands

      Endocrine glands - illustration

      Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the pace of chemical activity in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).

      Endocrine glands

      illustration

    • Bile pathway

      Bile pathway - illustration

      The biliary system is comprised of the organs and duct system that create, transport, store and release bile into the duodenum for digestion. Includes the liver, gallbladder and bile ducts (named the cystic, hepatic, common, and pancreatic duct).

      Bile pathway

      illustration

    • Biliary obstruction - series

      Presentation

    A Closer Look

     

    Self Care

     

      Tests for Bile duct obstruction

       

       

      Review Date: 5/11/2016

      Reviewed By: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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