Bile duct obstruction

Biliary obstruction

Bile duct obstruction is a blockage in the tubes that carry bile from the liver to the gallbladder and small intestine.

Causes

Bile is a liquid released by the liver. It contains cholesterol, bile salts, and waste products such as bilirubin. Bile salts help your body break down (digest) fats. Bile passes out of the liver through the bile ducts and is stored in the gallbladder. After a meal, it is released into the small intestine.

When the bile ducts become blocked, bile builds up in the liver, and jaundice (yellow color of the skin) develops due to the increasing level of bilirubin in the blood.

The possible causes of a blocked bile duct include:

Cysts of the common bile duct
Enlarged lymph nodes in the porta hepatis
Gallstones
Gallstones
Gallstones are hard deposits that form inside the gallbladder. These may be as small as a grain of sand or as large as a golf ball.
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Inflammation of the bile ducts
Narrowing of the bile ducts from scarring
Injury from gallbladder surgery
Tumors of the bile ducts or pancreas
Tumors that have spread to the biliary system
Biliary system
The biliary system creates, moves, stores, and releases bile into the duodenum. This helps the body digest food. It also assists in transporting wa...
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Liver and bile duct worms (flukes)

The risk factors for a blocked bile duct include:

History of gallstones, chronic pancreatitis, or pancreatic cancer
Chronic pancreatitis
Pancreatitis is swelling of the pancreas. Chronic pancreatitis is present when this problem does not heal or recurs and does not improve, gets worse...
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Pancreatic cancer
Pancreatic cancer is cancer that starts in the pancreas.
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Injury to the abdominal area
Recent biliary surgery
Biliary surgery
Open gallbladder removal is surgery to remove the gallbladder through a large cut in your abdomen. The gallbladder is an organ that sits below the li...
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Recent biliary cancer (such as bile duct cancer)
Bile duct cancer
Cholangiocarcinoma (CCA) is a rare cancerous (malignant) growth in one of the ducts that carries bile from the liver to the small intestine.
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The blockage can also be caused by infections. This is more common in people with weakened immune systems.

Symptoms

Symptoms may include:

Abdominal pain in the upper right side
Abdominal pain
Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly.
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Dark urine
Dark urine
Blood in your urine is called hematuria. The amount may be very small and only detected with urine tests or under a microscope. In other cases, the...
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Fever
Fever
Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
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Itching
Itching
Itching is a tingling or irritation of the skin that makes you want to scratch the area. Itching may occur all over the body or only in one location...
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Jaundice (yellow skin color)
Nausea and vomiting
Clay-colored or pale stools
Clay-colored or pale stools
Stools that are pale, clay, or putty-colored may be due to problems in the biliary system. The biliary system is the drainage system of the gallblad...
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Exams and Tests

Your health care provider will examine you and feel your belly.

The following blood test results could be due to a possible blockage:

Increased bilirubin level
Increased alkaline phosphatase level
Increased GGT enzyme level
Increased liver enzymes

The following tests may be used to investigate a possible blocked bile duct:

Abdominal ultrasound
Abdominal ultrasound
Abdominal ultrasound is a type of imaging test. It is used to look at organs in the abdomen, including the liver, gallbladder, spleen, pancreas, and...
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Abdominal CT scan
Abdominal CT scan
An abdominal CT scan is an imaging method. This test uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomog...
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Endoscopic retrograde cholangiopancreatography (ERCP)
Percutaneous transhepatic cholangiogram (PTCA)
Percutaneous transhepatic cholangiogram
A percutaneous transhepatic cholangiogram (PTC) is an x-ray of the bile ducts. These are the tubes that carry bile from the liver to the gallbladder...
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Magnetic resonance cholangiopancreatography (MRCP)
Endoscopic ultrasound (EUS)

A blocked bile duct may also alter the results of the following tests:

Amylase blood test
Gallbladder radionuclide scan
Gallbladder radionuclide scan
Gallbladder radionuclide scan is a test that uses radioactive material to check gallbladder function. It is also used to look for bile duct blockage...
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Lipase blood test
Prothrombin time (PT)
Urine bilirubin
Urine bilirubin
Bilirubin is a yellowish pigment found in bile, which is a fluid produced by the liver and stored in the gallbladder. This article is about a lab tes...
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Treatment

The goal 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 blockage. The gallbladder will usually be surgically removed if the blockage is caused by gallstones. Your provider may prescribe antibiotics if an infection is suspected.

If the blockage is caused by cancer, the duct may need to be widened. This procedure is called endoscopic or percutaneous (through the skin next to the liver) dilation. A tube may need to be placed to allow drainage.

Outlook (Prognosis)

If the blockage is not corrected, it can lead to life-threatening infection and a dangerous buildup of bilirubin.

If the blockage lasts a long time, chronic liver disease can result. Most obstructions can be treated with endoscopy or surgery. Obstructions caused by cancer often have a worse outcome.

Possible Complications

Left untreated, the possible complications include infections, sepsis, and liver disease, such as biliary cirrhosis.

When to Contact a Medical Professional

Contact your provider if you:

Notice a change in the color of your urine and stools
Develop jaundice
Have abdominal pain that doesn't go away or keeps recurring

Prevention

Be aware of any risk factors you have, so that you can get prompt diagnosis and treatment if a bile duct becomes blocked. The blockage itself may not be preventable.

Open References

References

Fogel EL, Sherman S. Diseases of the gallbladder and bile ducts. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 146.

Lidofsky SD. Jaundice. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 21.

Digestive system - illustration
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Digestive system
illustration
Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
Bile pathway - illustration
The biliary system is comprised of the organs and duct system that create, transport, store and release bile into the duodenum for digestion. Includes the liver, gallbladder and bile ducts (named the cystic, hepatic, common, and pancreatic duct).
Bile pathway
illustration
Biliary obstruction - series - Normal anatomy
Presentation

<strong>Biliary obstruction - series - Normal anatomy</strong><p>Bile is a digestive fluid secreted by the liver and stored in the gallbladder which normally is released into the duodenum portion of the small intestine through the sphincter of Oddi. Bile, released after a meal containing fats, aids in absorption and digestion of the fat.</p>

<strong>Indication</strong><p>Biliary obstruction occurs when the duct which transports bile from the liver to the small intestine (duodenum) is blocked by a stone, a tumor, an injury or inflammation of any of the ducts. A tumor in the pancreas may press in on the ducts, causing a backup of bile in the gallbladder. Blood tests may indicate a high level of bilirubin, a waste product of the liver, or diagnosis may come from an endoscopic examination. Untreated biliary obstruction may cause life-threatening infection or chronic liver disease.</p>

<strong>Procedure</strong><p>One method of relieving a blockage of the bile duct due to pancreatic tumors is the placement of a stent, a device designed to hold tube-shaped structures open. An endoscope (an instrument placed down the throat into the esophagus, through the stomach to the duodenum of the small intestine) helps the surgeon to see the blockage and to place the stent in the correct position. Dye may be injected and X-ray images taken to insure the stent is correctly placed and the flow of bile is restored.</p>

<strong>Aftercare</strong><p>Once the flow of bile is restored, the threat of infection and inflammation is decreased. However, the prognosis may not be significantly altered if the pancreatic carcinoma is otherwise untreatable. Reoccurence of the blockage (restenosis) may also occur, requiring further surgery or replacement of the stent.</p>

Digestive system - illustration
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Digestive system
illustration
Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
Bile pathway - illustration
The biliary system is comprised of the organs and duct system that create, transport, store and release bile into the duodenum for digestion. Includes the liver, gallbladder and bile ducts (named the cystic, hepatic, common, and pancreatic duct).
Bile pathway
illustration
Biliary obstruction - series - Normal anatomy
Presentation

A Closer Look

Gallstones and gallbladder disease

Self Care

Tests for Bile duct obstruction

Gallbladder radionuclide scan

Review Date: 5/4/2022

Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Health Library

Bile duct obstruction

Causes

Bile

Bilirubin

Gallstones

Biliary system

Chronic pancreatitis

Pancreatic cancer

Biliary surgery

Bile duct cancer

Symptoms

Abdominal pain

Dark urine

Fever

Itching

Clay-colored or pale stools

Exams and Tests

Abdominal ultrasound

Abdominal CT scan

Percutaneous transhepatic cholangiogram

Gallbladder radionuclide scan

Urine bilirubin

Treatment

Outlook (Prognosis)

Liver disease

Possible Complications

Sepsis

Cirrhosis

When to Contact a Medical Professional

Prevention

References

Digestive system - illustration

Digestive system

Endocrine glands - illustration

Endocrine glands

Bile pathway - illustration

Bile pathway

Biliary obstruction - series - Normal anatomy