What is a Biliary Obstruction?

Biliary obstruction is a potentially life-threatening condition caused by a blockage in the digestive system's bile ducts. Blockages of the bile ducts can develop for several reasons and may be indicative of a secondary condition, such as gallstones or a tumor. Treatment for an obstruction is centered on eliminating the blockage and usually involves surgery.

Bile is a substance composed of bile salts, cholesterol, and waste products, including bilirubin, which the digestive system uses to digest food and fats. When released by the liver, the acidic liquid travels through bile ducts to the gallbladder for storage. After an individual eats, the stored bile is released into the small intestine to aid with digestion. If the bile ducts are blocked, bile can accumulate in the liver, which increases bilirubin levels in the blood. The impairment of bile flow and accumulation of bilirubin can lead to a yellowing of the skin, a condition known as jaundice.

Several situations may lead to the development of a biliary obstruction. The formation of tumors or cysts within the bile duct can create an obstruction that restricts proper bile flow. Inflammation and trauma that affects the bile ducts or surrounding tissues may contribute to the development of a biliary blockage. Additionally, the formation of gallstones within the gallbladder may also create an obstruction that impairs the flow of bile.

Individuals who develop an obstruction may experience a variety of signs and symptoms. One of the most common signs of a bile obstruction is the development of abdominal pain localized in the upper right side of the abdomen. Symptomatic individuals may also experience nausea, vomiting, and fever. The presence of dark urine and pale-colored stools are also indicative of a biliary blockage. Individuals with a high concentration of bilirubin in their blood may also develop jaundice.

There are several diagnostic tests that may be administered to confirm the presence of a biliary obstruction. Initially, a physical examination and palpation of the abdominal area may be conducted to evaluate any distention, tenderness, or other abnormalities. Blood tests may be ordered to assess liver enzymes and bilirubin and alkaline phosphatase levels; results that indicate above normal levels of any of these substances may confirm the presence of a blockage. Imaging testing, including a computerized tomography (CT) scan and ultrasound, may be performed to evaluate the condition of the bile ducts and determine the presence and extent of any blockage. The elimination of the blockage is central to any treatment approach for a biliary obstruction.

If the blockage is due to the presence of stones, these may be treated during a procedure known as an endoscopic retrograde cholangiopancreatography (ERCP). Used to identify and remedy the narrowing or blockage of the bile ducts, an ERCP is employed to remove any blockage and broaden narrowed ducts to allow for proper bile flow. When the blockage is due to the presence of a tumor or cyst, these may be removed and tissue samples taken for further laboratory analysis. Surgery may also be conducted to bypass the blockage and remove the gallbladder if the obstruction is due to gallstones. If infection is present, antibiotics may be administered to eliminate the existing infection and prevent it from spreading.

Individuals who have a history of gallstones or pancreatitis may be at an increased risk for developing a biliary blockage. Injury to the abdominal area may also increase one’s chances for a bile duct obstruction. Additional factors that may contribute to the formation of an obstruction include recent open surgery to remove the gallbladder, known as an open cholecystectomy, and biliary duct cancer. Those with compromised immunity who develop certain infections may also be at a greater risk for a biliary blockage.

Symptoms associated with a biliary obstruction should not be ignored. If left untreated, bilirubin can increase to dangerous levels leading to the development of a life-threatening infection. Prognosis associated with this condition is dependent on a timely diagnosis, appropriate treatment, and the cause for the obstruction. Complications associated with a biliary obstruction include infection, liver disease, and sepsis.