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Bile duct obstruction

Definition

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

See also:

• Acute cholecystitis
• Choledocholithiasis
• Gallstones

Alternative Names

Biliary obstruction

Causes, incidence, and risk factors

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 levels of bilirubin in the blood.

The possible causes of a blocked bile duct include:

• Cysts of the common bile duct
• Enlarged lymp nodes in the porta hepatis
• Gallstones
• Inflammation of the bile ducts
• Trauma including injury from gallbladder surgery
• Tumors of the bile ducts or pancreas
• Other tumors that have spread to the biliary system

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 persons with weakened immune systems.

Symptoms

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

Signs and tests

Your health care provider will examine your abdomen and may be able to feel the gallbladder.

The following blood test results could be a sign of 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
• ERCP (endoscopic retrograde cholangiopancreatography)
• Percutaneous transhepatic cholangiogram (PTCA)
• Magnetic resonance cholangiopancreatography (MRCP)

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

• Amylase blood test
• Gallbladder radionuclide scan
• 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 health care 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 endoscope or percutaneous (through the skin next to the liver) dilation. A tube may need to be placed to allow drainage.

Support Groups

Expectations (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.

Complications

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

Calling your health care provider

Call your health care 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

Attasaranya S, Fogel EL.. Choledocholithiasis, ascending cholangitis, and gallstone pancreatitis. Medical Clinics of North America. 2008 Jul;92(4).