Bile Duct Obstruction
What is a bile duct obstruction?
A bile duct obstruction is a blockage in one of the tubes that carries bile. Bile is a product of the liver. It contains cholesterol, bile salts to help digest fats, and waste products, such as bilirubin.
After the liver makes bile, it travels through a network of microscopic tubes called hepatic ducts. These small ducts meet to form one large duct, called the common hepatic duct. Bile exits the liver through this duct. About half the bile goes into the small intestine (starting with the duodenum) and the rest goes to the gallbladder for storage. The gallbladder releases stored bile into the small intestine when food from a meal triggers it. Bile from the gallbladder flows through a different pathway, called the cystic duct. The cystic duct meets the common hepatic duct from the liver to form the last bile duct, called the common bile duct. A blockage in any of these tubes is a bile duct obstruction.
The most common cause of a bile duct obstruction is a gallstone. Gallstones form inside the gallbladder and can move into the common bile duct, blocking it. Cysts, tumors, inflammation and scarring are other bile duct obstruction causes.
Bile duct obstructions are more common in people with a history of or at high risk of gallstones. Surgery or injury to the liver, gallbladder, or biliary network can also increase the risk.
When a blockage occurs in any of the bile ducts, bile accumulates within nearby structures. As bile builds up in the liver, it causes jaundice and other symptoms, such as nausea, vomiting, and upper abdominal pain. Depending on the cause, these symptoms can develop abruptly or slowly with time. For example, gallstones may cause severe, acute symptoms. Tumors may cause a more gradual onset of symptoms.
Bile duct obstruction treatment usually involves surgery or an endoscopic procedure. The cause of the obstruction will determine what kind of surgery or procedure is necessary.
Left untreated, a bile duct obstruction can cause life-threatening complications. This includes infection, sepsis, and liver damage. Call your doctor right away if you notice symptoms of jaundice, such as yellow skin or eyes, dark urine, or pale stools. Seek immediate medical care for severe abdominal pain, high fever and chills, or persistent nausea and vomiting.
What are the symptoms of a bile duct obstruction?
Bile duct obstruction symptoms can start suddenly or gradually, depending on the cause. They are the result of bile backing up in the liver. Bilirubin levels in the blood can rise as the liver becomes congested with bile.
Common symptoms of a bile duct obstruction
Common bile duct obstruction symptoms include:
- Abdominal pain in the upper right-hand side
- Dark-colored urine or light brown urine
- Itching, which may be worse at night or in warm environments
- Jaundice, which is yellowing of the skin and whites of the eyes due to high bilirubin levels
- Pale or clay-colored stools or greasy stools
Serious symptoms that might indicate a life-threatening condition
In some cases, a bile duct obstruction can lead to life-threatening complications. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms, including:
- Nausea and vomiting that doesn’t allow you to keep down liquid
- Severe abdominal pain
What causes a bile duct obstruction?
Gallstones most commonly cause a bile duct obstruction. These hardened fragments develop inside the gallbladder. If they move out into the common bile duct, they can block it. Blockages can also occur in any of the bile ducts of the liver for a variety of reasons. This includes cysts, cancerous and noncancerous tumors, and strictures, which are scars that narrow the duct after surgery, infection or inflammation. Lastly, parasite infections with flukes can also cause bile duct disease and obstruction.
Bile duct obstruction after gallbladder removal is possible, due either to biliary tract injury from surgery or to the other potential causes.
What are the risk factors for a bile duct obstruction?
Since gallstones are the main cause of a bile duct obstruction, having a history of or being at risk of developing them increases your risk of an obstruction.
Risk factors for gallstones include:
- Age 40 or older
- Certain medical conditions, including diabetes, high cholesterol, liver disease, and blood disorders
- Family or personal history of gallstones or gallbladder attacks
- Female sex
- Overweight and obesity
- Rapid weight loss
Other bile duct obstruction risk factors include chronic pancreatitis, biliary or pancreatic cancer, abdominal injuries, and recent biliary surgery. Travel to southeast Asia puts you at risk of a liver fluke infection if you eat undercooked fish while in the region.
Reducing your risk of a bile duct obstruction
Reducing your risk of gallstones may help you lower your risk of a bile duct obstruction. You may be able to reduce your risk by:
- Getting regular physical exercise
- Eating a low-fat, low-cholesterol, and high-fiber diet
- Losing weight slowly and steadily instead of through crash diets
- Maintaining a healthy body weight
If you are concerned about your risk of a bile duct obstruction, talk with your doctor. Find out what puts you at risk and ask how to manage your risk.
How is a bile duct obstruction treated?
Regardless of the cause, the goal of bile duct obstruction treatment is to alleviate the blockage. This usually means surgery or an endoscopic procedure. If a gallstone is the cause, most cases will require gallbladder removal along with removal of any stones blocking the ductal pathways. Usually, doctors can do this with laparoscopic surgery. Removing the gallbladder is the best way to prevent future problems. Once you have had a gallstone, you have a 70% chance of having another one.
Otherwise, doctors may be able to remove the blockage or bypass it. There is also a procedure that widens the bile duct by dilating it and placing a stent.
What are the potential complications of a bile duct obstruction?
Potential complications of a bile duct obstruction are serious and can be life threatening. This includes infection, which can lead to sepsis, and dangerously high levels of bilirubin in the blood. Long-term bile duct blockages can lead to chronic liver disease, such as biliary cirrhosis. Medications can help relieve symptoms of chronic liver disease and may prolong the time until liver failure and the need for a liver transplant.