Biliary Disorders

Biliary Tract Disease

The biliary tract is comprised of the liver, gallbladder and bile ducts, which work together to form bile and release it into the small intestine to aid in the digestion of fats. Bile is formed by the liver, stored by the pear-shaped gallbladder and drains out into the common bile duct, which opens into the small intestine. Many diseases of the biliary tract can interrupt the passage of bile for digestion by blocking the ducts.

One of the common causes of blockage includes gallstones, which are small stones that form inside the gallbladder and block the common bile duct causing the bile to backup. Blockage of the common bile duct can lead to severe infections such as cholangitis and cholecystitis. Other causes of blockage may include bile duct cancer, scar formation (strictures) following inflammation, infection or surgery, primary sclerosing cholangitis (inflammation) and biliary cirrhosis (autoimmune disease).

Biliary tract diseases can manifest symptoms gradually or suddenly depending on the extent of blockage. Some of the common symptoms include yellowing of the skin or eyes, itchy skin, fatigue, loss of appetite, loss of weight, fever and abdominal pain.

Problems with the biliary tract are diagnosed by reviewing your medical history and performing a thorough physical examination. Blood tests may be ordered to check for bilirubin, signs of inflammation and obstruction. Your doctor may order other tests such as MRI or CT scan of the liver, endoscopic retrograde cholangiopancreatography (a small camera is directed down your mouth), bile duct X-rays and liver biopsy to confirm the diagnosis.

Treatment depends on the type of disease. The first line of treatment is antibiotics and other medication. Other procedures may be performed once infection subsides. Gallstones can be removed by a technique called endoscopic retrograde cholangiopancreatography (ERCP), where a long lighted tube with a camera (endoscope) is inserted through the mouth to the site of blockage. It helps your surgeon to view the operating site clearly, and capture and remove the gallstones in a mesh basket. Bile duct cancer and a severely infected gallbladder can be removed with surgery. For conditions such as primary sclerosing cholangitis and biliary cirrhosis which causes failure of the liver, a liver transplantation may be required for long term survival.