Bile duct obstruction

The bile ducts are tubes that carry bile from the liver to the gallbladder and small intestine. Bile duct obstruction has long been known to be present in both malignant / nonmalignant liver disease

Bile is manufactured in the liver and helps the body digest all fats. The bile ducts course throughout the liver collecting bile, then travel to the gall bladder where bile is stored. When bile is needed, such as after a fatty meal, it is released into the small intestine via another duct which connects the gallbladder to the small intestine.

Bile is a liquid secreted by the liver that contains cholestrol, bile salts, and waste products such as bilirubin. Bile salts aid in the digestion of fats. Bile passes out of the liver through the bile ducts and is concentrated and stored in the gallbladder until it is released into the small intestine after a meal to help with all fat digestion.

When the bile ducts become blocked, bile accumulates in the liver, and then jaundice (yellow color of the skin) develops due to the accumulation of bilirubin in the blood.

The possible causes of a blocked bile duct include:
* Gallstones Tumors of the bile ducts or pancreas
* Other tumors that have spread to the biliary system
* Trauma including injury from surgery
* Choledochal cysts
* Enlarged nodes in the porta hepatis
* Bile ducts inflammation

The risk factors include:
* A history of gallstones, or pancreatic cancer
* Recent biliary surgery
* Recent biliary cancer
* Abdominal trauma

Bile duct cancers, also called cholangiocarcinomas, may arise in many locations in and around the liver. The only definitive treatment is the complete surgical removal of the tumor, which is not often possible. If the cancer cannot be entirely removed, the principal goals of therapy become the relief of symptoms caused by the accumulation of bile, and relief from pain

There are no signs or symptoms unique to bile duct cancer. Even if the findings associated with bile duct cancer are present, other explanations, such as gallstones, are far more likely. Symptoms generally develop slowly and are often subtle. Jaundice (the skin turning yellow) and itching are the most common signs. Jaundice is caused by the accumulation in the skin of a component of bile (bilirubin) that normally empties into the intestines after traveling through the bile ducts.

Bloating, weight loss, decreased appetite, fever, nausea or an enlarging abdominal mass are all signs that may be attributable to bile duct cancer. Pain usually signifies advanced disease.

A tumor in the bile ducts may sometimes be detected using ultrasound scanning or computed tomography (CT). A tissue sample can usually be obtained by inserting a thin needle through the skin under ultrasound or CT guidance. Endoscopic retrograde cholangiopancreatography (ERCP) may also be used to provide a tissue sample. ERCP allows bypass tubes (stents) to be inserted to ensure that bile can flow around the obstruction, which also helps control pain and relieve itchiness. A cancerous tumor usually cannot be removed surgically. Most cancerous tumors do not respond well to radiation therapy. Chemotherapy for tumors that have spread from other parts of the body (metastatic tumors) may sometimes provide some relief from the symptoms but ultimately does not dramatically improve survival.