What Causes Biliary Obstruction? Symptoms and treatment

The bile duct, whose main job is to transport the bile produced by the liver to other parts of the body, cannot function in case of obstruction. Therefore, it causes many problems. In this content, we will answer questions such as what is the bile duct, what causes obstruction, what are the symptoms and how is the treatment.

What is the Bile Duct?

The bile duct is an important structure related to the digestive system in our body. Bile is a digestive fluid produced in the liver and stored in the gallbladder. Bile contains digestive enzymes that are used to digest fats and facilitate their absorption. The bile duct carries this important fluid from the liver to the gallbladder and then to the duodenum.

The bile duct acts as a bridge between the bile produced in the liver and the gallbladder. Bile produced in the liver is transported to the gallbladder through the bile ducts. The gallbladder acts as a reservoir on the bile duct, regulating the amount of bile needed for the digestive process. Especially when fatty foods are consumed, the gallbladder contracts and bile is secreted into the duodenum through the bile duct.

The bile duct consists of two main ducts, right and left. The right bile duct comes from the right lobe of the liver and the left bile duct comes from the left lobe of the liver. These two ducts together form a common bile duct. The common bile duct merges into the cystic duct, a duct that connects to the gallbladder so that the bile stored in the gallbladder is transported to the duodenum for use in the digestive process.

Bile duct obstruction is a condition that blocks the flow of bile. This blockage can occur for many different reasons. Gallstones can block the bile duct and block its flow. In addition, narrowing of the tissues in the bile ducts, tumors or infections can also cause blockage. Obstruction of the bile ducts can lead to bile accumulation and liver damage. As a result, symptoms such as jaundice, abdominal pain, nausea and vomiting may occur.

What is Biliary Obstruction?

Biliary obstruction is a condition where the flow of bile is blocked. Bile ducts act as pathways that carry bile from the liver to the gallbladder and then to the duodenum. However, the flow in these ducts can be blocked for various reasons, causing the bile ducts to become clogged.

Gallstones are among the leading causes of bile duct obstruction. Stones formed in the gallbladder can block the bile duct, leading to obstruction of bile flow. These stones completely or partially block one or more ducts in the bile duct, preventing the flow of bile. As a result, bile accumulation and bile duct infections can occur.

Other factors that cause bile duct obstruction include tumors. Tumors that form in or near the bile ducts of the liver can block bile flow. Tumors grow in the duct, narrowing the diameter of the duct or completely blocking it. In this case, bile accumulates in the liver and leads to various health problems in the body.

What Are the Symptoms of Biliary Obstruction?

Biliary obstruction is a condition in which the flow of bile is blocked and can manifest with a variety of symptoms. People with biliary obstruction may experience the following symptoms:

1. Jaundice

The most common symptom of bile duct obstruction is jaundice. Jaundice manifests as a yellowing of the skin, whites of the eyes and mucous membranes (such as mouth, nose, genitals). The blockage causes bile to build up in the liver, leading to an increase in a pigment called bilirubin in the body.

2. Abdominal pain

Obstruction of the bile ducts can cause pain in the abdomen. This pain is usually felt in the upper right quadrant and can sometimes radiate to the upper back. The pain may increase, especially when fatty foods are consumed or when fasting for a long time.

3. Nausea and vomiting

People with bile duct obstruction may experience nausea and vomiting. Since the flow of bile is blocked, a feeling of nausea sets in and can occasionally lead to vomiting.

4. Loss of appetite and weight

Loss of appetite and weight loss are common symptoms in people with biliary obstruction. During the digestive process, bile facilitates the digestion of fats. The blockage hinders the absorption of fats, leading to loss of appetite and weight loss.

5. Color change in urine and stool

Blockage of the bile ducts can cause urine and stool to change color. Urine can be dark in color while stool can be light or clay colored. This happens because of the irregularity of bile flow.

6. Fatigue and weakness

Bile duct obstruction leads to the body’s inability to adequately digest and absorb nutrients. This can result in a lack of energy, a feeling of tiredness and weakness.

What Are the Causes of Biliary Obstruction?

Bile duct obstruction can be caused by several reasons that lead to bile flow obstruction. Here are some of the most common causes of bile duct obstruction:

Gallstones

One of the most common causes of biliary obstruction is gallstones. Stones formed in the gallbladder can block the bile duct, impeding bile flow. Gallstones are formed by the crystallization of cholesterol or bilirubin substances that have accumulated in the gallbladder.

Biliary tumors

Another cause of bile duct obstruction is bile duct tumors. Tumors that develop in or near the liver or bile ducts can narrow or completely block the duct. Tumors can be malignant or noncancerous (benign).

Constrictions of the bile ducts

Constrictions in the bile duct can also cause obstruction. The diameter of the bile ducts shrinks due to inflammation, scarring, or other structural changes. In this case, the flow of bile is blocked and congestion occurs.

Parasitic infections

Parasites can lodge in the bile duct and cause blockage. Parasitic infections, especially common in tropical regions, can lead to blockage and inflammation in the bile ducts.

Pancreatic inflammation

Inflammation of the pancreas, called pancreatitis, can lead to bile duct obstruction. In the case of pancreatitis, enzymes secreted by the pancreas can build up in the bile ducts and cause blockage.

Congenital abnormalities

Some people may have congenital bile duct abnormalities. These abnormalities can cause changes in the structure or location of the duct and block bile flow.

How is biliary obstruction treated?

Treatment for biliary obstruction depends on the cause. ERCP, lithotripsy (shock wave therapy), drug therapy and traditional surgical methods are used in the treatment of biliary obstruction. The most preferred of these is the ERCP method.

ERCP method

The ERCP method is an undemanding procedure used for diagnosis and treatment using x-rays and imaging. The bile ducts and pancreatic duct are viewed through a special endoscope.

With this method, which is performed in a short time, bile duct stones that occur in patients who have undergone gallbladder surgery are surgically treated. In patients undergoing both bile duct and gallbladder surgery, the bile ducts are cleaned endoscopically before surgery. In this way, the operation is simplified by ensuring that the operation is limited to the gallbladder and the patient is discharged in a short time.

How is ERCP applied?

The implementation of the ERCP method consists of several steps. Before the procedure, the patient must be fasted for 6 hours. If there is a blockage or inflammation in the bile ducts, the patient should be given antibiotics.

During the treatment, the patient’s throat is anesthetized with a spray. The patient is placed face down with his head turned to the right. A relaxant is administered intravenously. Values ​​such as heart rate and blood pressure are monitored by the monitor.

The endoscope is advanced through the mouth and delivered to the area where the bile ducts and pancreatic duct are opened. A catheter is inserted into the pancreatic duct in the same way as for imaging, and a film is made by administering contrast material.

Depending on the conditions detected in the film, endoscopic treatment may be applied at the same time. Here, procedures such as enlarging the hole through which the bile ducts exit into the duodenum, removing the stones, and placing a tube in place can help relieve the patient’s jaundice by providing bile flow to the narrowed area.

In which situations is ERCP applied?

The ERCP method is the most commonly used method for biliary obstruction. This treatment method is often preferred to remove bile duct stones without surgery. This method is also used to make a definitive diagnosis in bile duct and pancreatic tumors that cause jaundice by causing obstruction of the bile ducts.

In addition, this method is also used to remove jaundice and improve the patient’s condition before surgery, to treat biliary fistulas that may occur after some operations, and to detect possible bile duct injuries.

What happens if the bile duct is blocked?

Biliary obstruction causes many consequences. The most important of these are accumulation of bile in the liver, jaundice and secondary biliary cirrhosis.

How is bile duct obstruction diagnosed?

To understand biliary obstruction, we need to know the symptoms it presents. These symptoms include back pain, pain in the right shoulder, nausea, vomiting, light-colored stools, excessive gas and other digestive problems, diarrhea, darkening of the color of the urine, a feeling of pain in the upper right abdomen that suddenly and quickly becomes heavy.

How long does the ERCP process take?

The ERCP process does not take long. After preparations, this endoscopic treatment method is performed within 30-40 minutes. After this procedure, the patient is observed in the hospital for 3-4 hours.

How To Open Gallbladder Duct Obstruction?

The duct obstruction in the gallbladder is opened endoscopically. This opening can be done while the snake enters the mouth. In cases where this method cannot be used, the gallbladder obstruction is surgically opened.

Do gallstones pass without surgery?

Gallstones, which can have serious consequences if left untreated, can be removed by endoscopic treatment. Thanks to this method, which is not a surgical treatment, you can remove the stones in the gallbladder in a short time.

Is ERCP dangerous?

When performed by specialist doctors, ERCP has a much lower risk compared to classical operations, and complications occur at a rate of 5-7%. The most common complications are cholecystitis, cholangitis, pancreatitis, perforation and bleeding in the small intestine.