Bile duct obstruction

Definition

The bile ducts carry bile from the liver to the gallbladder, and from the gallbladder to the small intestine. Any of these ducts can become obstructed (blocked) by gallstones or other causes.

Causes, incidence, and risk factors

Bile is a liquid secreted by the liver that contains cholesterol, bile salts, and waste products such as bilirubin. Bile salts aid in the digestion of fats. Bile passes out of the liver through the bile ducts and is concentrated and stored in the gallbladder until it is released into the small intestine after a meal to help with fat digestion.

When the bile ducts become blocked, bile accumulates in the liver, and jaundice (yellow color of the skin) develops due to the accumulation of bilirubin in the blood.

The possible causes of a blocked bile duct include:

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

The risk factors include:

• A history of gallstones, chronic pancreatitis, or Pancreatic cancer
• Recent biliary surgery
• Recent biliary cancer (such as bile duct cancer)
• Abdominal trauma.

In immunosuppressed patients, the blockage can be caused by infections.

Symptoms

• Pale-colored stools (caused by lack of bilirubin)
• Dark urine (caused by bilirubin excreted in the urine)
• Jaundice (yellow skin color)
• Itching
• Abdominal pain in the upper right quadrant
• Fever
• Nausea and vomiting

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 indicate a possible blockage:

• Elevated bilirubin
• Elevated alkaline phosphatase
• Elevated liver enzymes

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

• Gallbladder radionuclide scan
• Urine bilirubin
• Amylase

Treatment

The goal is to address 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 will prescribe antibiotics for if an infection is suspected.

If the blockage is caused by cancer, the duct may need to be expanded using an endoscope or percutaneous (through the skin) dilation. A tube may need to be placed to allow drainage.

Expectations (prognosis)

If the blockage is not corrected, it can lead to life-threatening infections. 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.

Illustrations

Digestive system

Endocrine glands

Bile pathway

Biliary obstruction - series

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Biliary obstruction