What you need to know about
jaundice and biliary obstruction
While jaundice may sound familiar to most people, one of its possible causes — biliary obstruction — should not be ignored.
Jaundice’s familiar symptoms – yellow-tinted eyes, skin and urine – can be caused by a myriad of factors.
Besides hepatitis and liver diseases, biliary obstruction is another possible cause. To better understand the condition Better health talks to board-certified gastroenterologist and hepathologist Dr. Yudhtana Sattawatthamrong who has more than 20 years experience in this field.
How the bile system works
“The bile duct system, which is part of the digestive system, can be compared to branches of a tree,” explains Dr. Yudhana. “Bile is a dark green or yellow-brown liquid secreted by the liver. It passes through tiny tubes called bile ducts connected to the gallbladder where it is stored and becomes concentrated and intensified. When you eat, food is transported to the stomach and the intestine, which triggers secretion of a hormone to stimulate the gallbladder to release bile into the small intestine (the duodenum) to facilitate fat digestion and absorption.”
Causes of blockages
Bile duct blockage is usually caused by two conditions: stones and tumors. “Bile duct obstruction caused by stones can be found anywhere in the bile duct system,” says Dr. Yudhana. “Gallstones occur when bile, which is normally fluid, forms stones. Gallstones commonly are lumps of fatty, cholesterol-like material that has solidified and hardened. Additionally, bile pigments or calcium deposits can also form gallstones.”
Gallstones become more common with increasing age after 40. The risk of forming gallstones also increases with pregnancy, obesity, diabetes, liver cirrhosis, and thalassemia. Women with abnormal hormone levels or who use contraceptive pills have increased risk of forming gallstones.
“When bile ducts become blocked, bile builds up in the liver and spreads into the blood stream. Jaundice develops due to increasing levels of a blood component called bilirubin, which could lead to life-threatening infections,” Dr. Yudhana continues.
Patients with obstructed bile ducts caused by stones and tumors can have differing symptoms. “Patients with biliary obstruction caused by stones may experience jaundice accompanied by upper abdominal
pain that radiates to the back, fever, shivering cold, and infection,” says Dr. Yudhana. “Patients who have blocked bile ducts caused by tumors will experience jaundice, but not abdominal pain since tumors gradually develop and grow.
The bile ducts are increasingly blocked over time, causing them to swell.” Ninety percent of biliary obstruction caused by tumors can further develop into cancer. In Thailand, bile duct cancer is common in the northeastern region where people consume uncooked or undercooked freshwater fish containing parasites. When the parasites enter the bile duct, their waste products can cause bile duct cells to develop uncontrollably which can develop into cancer.
Diagnosis and treatment
To diagnose biliary obstruction doctors check the patient’s health history and perform a blood test to confirm the cause of the jaundice. An ultrasound test is also prescribed to examine the bile duct blockages. “Doctors examine the biliary tree thoroughly, including intrahepatic bile ducts, the common hepatic bile duct, and the pancreatic duct. In most cases ultrasound images are sufficient for doctors to diagnose and plan treatment. In cases where an ultrasound is not definitive, we recommend a CT scan, MRI, MRCP, or an Endoscopic Retrograde Cholangiopancreatography (ERCP),” says Dr. Yudhana.
Bile duct blockages can be life threatening if left untreated. “In the past, treating biliary obstruction caused
“The risk of forming gallstones increases with thalassemia, women with abnormal hormone levels, pregnancy, obesity, diabetes, liver cirrhosis, and age over 40.”
Dr. Yudhtana Sattawatthamrong
by gallstones required open surgery,” Dr. Yudhana points out. “A six-inch abdominal incision was made to remove stones in the bile duct. Nowadays, the surgery is done using ERCP, which allows doctors to diagnose and treat biliary blockage by bile duct stones simultaneously. This procedure doesn’t require any incision in the abdomen and promotes faster recovery.”
In an ERCP procedure, a flexible tube with a micro-camera is inserted in the mouth and gently guided down the throat into the esophagus, stomach, and duodenum until it reaches the point where ducts from the pancreas and gallbladder drain into the duodenum. If a bile duct stone is present, the doctor can sometimes remove it by dragging it into the small intestine so the body can eliminate it during bowel movement.
“To treat bile duct blockage caused by tumor the doctor needs to obtain a tissue sample for further testing to confirm if the tumor is malignant, which can also be done during an ERCP session,” Dr. Yudhana says. “If the tumor is cancerous the doctor will plan additional treatment. An important point to consider is if the patient also has jaundice caused by bile duct blockage. Treating this requires inserting a stent or undergoing surgery to bypass the bile duct blockage and drain the bile fluid into the intestine before treating the cancer.”
While diagnoses of biliary blockage can be done quite easily, spotting the first-stage warning signs or taking preventive approaches still remain challenging. However, taking control of your health by eating healthy and doing regular exercise are very helpful in preventing these conditions.
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