Biliary obstruction

Biliary 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.

Alternative Names:

Bile duct obstruction

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:
- cholelithiasis (gallstones)
- chronic pancreatitis
- 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
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)

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

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.

Review Date: 10/27/2002
Reviewed By: Jenifer K. Lehrer, M.D., Department of Gastroenterology, Graduate Hospital, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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