Biliary obstruction

Alternative names
Bile duct obstruction

Definition
Biliary obstruction involves the blockage of any duct that carries bile from the liver to the gallbladder or from the gallbladder to the small intestine.

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 an obstruction occurs in the bile ducts, bile accumulates in the liver, and jaundice (yellow color of the skin) develops due to the accumulation of bilirubin in the blood.

Causes of obstruction include the following:

     
  • 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

Risk factors include the following:

     
  • History of any of these conditions:       o Cholelithiasis (gallstones)       o Chronic pancreatitis       o Pancreatic cancer  
  • Recent biliary surgery  
  • Recent biliary cancer (such as bile duct cancer)  
  • Abdominal trauma.

In immunosuppressed patients, obstructions 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 practitioner will examine your the abdomen and may be able to palpate (feel) the gallbladder.

Blood tests that show obstruction:

     
  • Bilirubin is elevated.  
  • Alkaline phosphatase is elevated.  
  • Liver enzymes are elevated.

Tests that show obstruction in the bile duct:

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

Biliary obstruction may also alter the results of the following tests:

     
  • Gallbladder radionuclide scan  
  • Urine bilirubin  
  • Amylase

Treatment

The objective 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 obstruction. The gallbladder will usually be surgically removed if the biliary obstruction is caused by gallstones. Your health care provider will prescribe antibiotics for biliary obstruction if infection is suspected.

In blockage caused by cancer, endoscopic (using an endoscope) or percutaneous (through the skin) dilation of the obstruction and placement of a tube for drainage may be required.

Expectations (prognosis)

If biliary obstruction is not corrected, it can lead to infections that can be life-threatening. If the obstruction lasts a long period of 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
Complications include infections, sepsis, and liver disease such as biliary cirrhosis from untreated obstruction.

Calling your health care provider
Call your health care provider if you notice a change in the color of urine and stools or the development of jaundice.

Prevention
Awareness of risk factors can allow prompt diagnosis and treatment of biliary obstruction. The obstruction itself may not be preventable.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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