Obstruction of the bile ducts
Gastroenterology / / August 12, 2017
What is obstruction of the bile ducts
obstruction (from the Latin «obstructio» -. Hindrance, obstruction) of the bile ducts (biliary tract) - their obstruction, blocking,blockage.Bile ducts (channels coming from the gallbladder) carry bile from the liver, where it is formed, and the gallbladder where it is stored, by the pancreas into the small intestine.
bile - dark-green or yellowish-brown liquid, which is secreted by the liver and is the main task - to digest fats.Most of the bile is released directly into the small intestine through the sphincter of Oddi (smooth muscle is on the inner surface portion of the duodenum), but the rest is stored in the gallbladder.Once people take the food, the gallbladder releases bile, which aids in digestion and absorption of fats.Bile also helps rid the liver of waste and toxins.
In the human body there are several types of the bile ducts, the two main types are located in the liver are: intrahepatic and extrahepatic ducts.
Intrahepatic channel is a pipe system for the collection and transport of bile in the extrahepatic ducts.Extrahepatic ducts begin in two parts: one - on the right side of the liver, and the other - to the left.Going from the liver, they are combined into the common hepatic duct leading directly to the small intestine.
bile ducts pass into the common hepatic duct and are called "common bile duct" (or "common bile duct") from this point on.Before the common bile duct empties into the small intestine, it passes through the pancreas.
Causes and biliary tract obstruction, the risk factors
biliary obstruction can be caused by a number of factors related to the bile ducts, liver, gallbladder, pancreas and small intestine.Below are some of the most common reasons:
- cyst of common bile duct;
- inflammation of the bile ducts;
- narrowing of the bile ducts of scars;
- injury from a previous surgery of the gallbladder;
- tumors that have spread to the liver, gallbladder, pancreas or bile ducts;
- strictures (abnormal narrowing) of the bile ducts;
- enlarged lymph nodes in the liver of the gate;
- trauma associated with the gallbladder or liver surgery;
- tumors of the bile ducts;
- infection, including hepatitis;
- cirrhosis (scarring of the liver, severe liver damage).
Risk factors include:
- history of gallstones,
- chronic pancreatitis,
- pancreatic cancer;
- trauma abdominal (peritoneal) region;
- recent surgical procedures on the bile ducts;
- recent cancer of the bile ducts;
- blockage of the bile ducts, cause infection (this is more common in individuals with weakened immune systems);
- injury in the right part of the abdomen;
- rapid weight loss.
- Removal of the gallbladder (cholecystectomy)
- Cholecystectomy from the cervix
- Echinococcosis gallbladder
- operations on the biliary tract and liver
- Bilirubin: what is it?
Symptoms obstruction of the bile ducts
- pain in the upper right corner of the abdomen;
- dark urine;
- fever (fever);
- jaundice (yellow color of the skin and whites of the eyes);
- nausea and vomiting;
- pale stools;
- weight loss.
diagnosis of obstruction of bile ducts
- A blood test and liver function. Blood tests, tend to exclude certain conditions: such as cholecystitis (inflammation of the gallbladder);cholangitis (inflammation of the common bile duct) and increased levels of bilirubin (liver waste product), liver enzymes and alkaline phosphatase.All this may indicate a loss of bile.
following blood parameters may be related to a possible blocking:
- increase in bilirubin;
- increased alkaline phosphatase;
- increase in liver enzymes;
- blood amylase (a blood enzyme);
- lipase (biochemical analysis) blood;
- prothrombin time (PT - analysis, reflecting the clotting time).
- ultrasound. As a rule, the first study performed on all suspected obstruction of the biliary tract.Ultrasound makes it easy to visualize the gallstones.
- Radionuclide scan of the bile ducts . use of radioactive material gives a valuable insight into the gallbladder and any possible obstacles.
- Computed tomography (CT) - combines several small X-rays.
- Endoscopic retrograde cholangiography - x-ray of the bile ducts.
- Magnetic resonance imaging (MRI) - provides detailed images of the liver, gallbladder, pancreas and bile ducts.
- Magnetic resonance cholangiopancreatography - used to diagnose blockage of the bile ducts and pancreas.
- Endoscopic retrograde cholangiopancreatography (ERCP) - uses an endoscope and X-rays.This is both a diagnostic and therapeutic tool that will not only allow the surgeon to see the bile ducts, but also used in the treatment.This tool is particularly useful because it can be used to remove stones.It is also used to obtain a biopsy (taking a sample of tissue to check for cancer cells in it) in cases of tumors.
Treatment obstruction of the bile ducts
goal of treatment of the bile duct obstruction is relieved and the release (at least partially) by blocking them.Stones can be removed using an endoscope during endoscopic retrograde cholangiopancreatography.
In some cases, surgery is required to bypass the lock space.The gallbladder is usually removed surgically, if the lock is caused by gallstones.Your doctor may prescribe antibiotics if infection is suspected.If the blockage is caused by cancer, you may need to expand the channel endoskoicheskim or percutaneous extension.
Some of the treatment options may include:
- cholecystectomy - removal of the gallbladder in the presence of stones in it;
- endoscopic retrograde cholangiopancreatography - to remove small stones from the common bile duct or stent placement (construction, tube that is placed into the lumen of hollow organs and provides a portion of the extension, the narrowed pathological process; provides a patency of bodily fluids) inside the duct for the recoverythe outflow of bile.
- Sphincterotomy. If gallstones are present in the common bile duct, the surgeon can perform a sphincterotomy bile duct.This procedure also osuschestvlyaettsya using endoscopic retrograde cholangiopancreatography.In the small intestine small incision is performed using an endoscope, which extend the common bile duct into the duodenum.Gall stone out through the resulting hole, thereby freeing up the flow of bile, buyout can move freely.If there is swelling, which also causes a narrowing of the bile ducts, plastic or metal stent can be placed into the bile duct, thus keeping it open, and restoring patency of the bile duct and the normal flow of bile.
- Gallstones (cholelithiasis), causes, diagnosis and treatment
- cholecystitis acute and chronic
- Abdominal pain and their underlying causes
- gallbladder cancer: causes,symptoms, stages, treatment
- Cancer of the bile duct (Cholangiocarcinoma)
Surgical treatment of obstruction of bile ducts
One method of restoring patency of the bile duct due to tumors of the pancreas - placement of the stent at the site of the narrowingbile duct.Such operations are called palliative surgery, or operations to relieve the symptoms.
endoscope is placed into the esophagus and is carried out through the stomach into the duodenum.This allows the surgeon to see the blocking of the stent and placed in the correct position.Before making X-ray images, a dye may be introduced to help deliver the stent to the proper position and restore the flow of bile.Once restored the flow of bile, the threat of infection and inflammation is reduced.However, the prognosis may not be substantially modified, if at the time of the procedure, the patient - an incurable cancer of the pancreas.
can also occur repetition obstruction (restenosis) that requires further surgery or stent replacement.
If not treated obstruction of the bile ducts, it can lead to life-threatening infections and dangerous accumulation of bilirubin.If obstruction lasts for a long time, this can lead to chronic liver disease.Most obstructions can be treated by endoscopy or by surgery.At the same time the obstacles caused by cancer are often given the worst result.
If untreated, possible complications include infection, sepsis, liver disease (eg, cirrhosis).It is necessary to consult a doctor if there were changes in the color of urine and stool, or if you develop jaundice.
Everyone should be aware of any risk factors, to obtain prompt diagnosis and treatment, if the bile duct is blocked.Lock biliary tract itself will not disappear if you do not take drastic measures and not change their lifestyle, diet.