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Bile Duct Obstruction

What is the biliary tree?

The biliary system is conduit for bile from the liver to pass into the small intestine (i.e., duodenum) to help with the digestion of food.

What is bile duct cancer?

Bile duct cancer (cholangiocarcinoma) is a cancerous (malignant) growth in the ducts that carries bile from the liver to the small intestine. Cancer of the bile duct is rare and is most prevalent in people ages 50 to 70. Symptoms are generally due to obstruction, a blockage in the tubes (or ducts) that carry bile from the liver to the gallbladder and small intestine:

  • Jaundice (e.g., turn yellow) or yellow eyes
  • Clay-colored stools;
  • Fever; Itching;
  • Loss of appetite;
  • Pain in the upper right
  • Dark urine
  • Fever

Causes of Bile Duct obstruction

Possible causes of bile duct obstruction include cysts of the common bile ducts, enlarged lymph nodes in the porta hepatis, or inflammation of the bile duct. These are unusual causes. Most of the time the biliary tree is blocked by stone(s), cancer, or narrowing brought about by intense inflammation, sometime due to previous surgery. For example, the bile duct rarely, but too often, injured during gallbladder surgery.

Diagnosis of cholangiocarcinoma , biliary obstruction, or biliary injury:

Diagnosis of cholangiocarcinoma , biliary obstruction, or biliary injury starts with a physical exam and lab tests, followed by one or more of these procedures.

  1. Ultrasound- Sound waves can be used to form images of the organs in the abdomen to identify a tumor.
  2. Computerized tomography (CT) scan- CT scans generate detailed cross-sectional images of the body that reveal if cancer has invaded other tissues or organs.
  3. Magnetic resonance imaging (MRI) - MRI technology produces precisely detailed images of the bile ducts, liver and tumor, using magnetic field and radio waves.
  4. Biopsy or Fine-needle aspiration (FNA) - During FNA, a doctor administers local anesthetic before carefully guiding a small needle through the skin and abdomen into the bile ducts. Biopsies through the skin are generally to be avoided. Such biopsies do NOT change the care given and can spread cancer.
  5. Endoscopic retrograde cholangiopancreatography (ERCP) - ERCP uses a lighted tube inserted through your mouth, down through the esophagus, into the stomach and then into the small intestine (duodenum) to see the bile ducts. The catheter is then placed into the bile duct and a cholangiogram is obtained.
  6. Cholangiogram- A cholangiogram is an X-ray of the bile ducts. Dye is injected and X-rays are taken which give a road map to the biliary tree.
  7. Positron emission tomography (PET) scan- A PET scan is a noninvasive 3-D imaging technique using a "marker" that goes where cells are hypermetabolic (i.e., burning through calories).

Definitive Treatment

The goal of treatment is to relieve the blockage. First, the cause of obstruction must be made and then the location of the obstruction must be determined. For example, if the biliary tree is obstructed by a stone, stones may be removed using an endoscope during ERCP.

In other circumstances, surgery is required to bypass or remove the blockage. Operative intervention is highly suggested if :

  1. Deterioration: more illness, worsening exam
  2. Progression of obstruction
  3. Failure to improve
  4. Perforation
  5. Tumor mass
  6. Failure of nonoperative measures

Complete removal of a tumor is the only effective and potential curative treatment for cancers of the lower bile duct. Call our office today to discuss your medical situation or make any appointment.

Such a surgical procedure requires the skill and knowledge of a truly experienced team. Dr. Ross and Dr. Rosemurgy of The Southeastern Center for Digestive Disorders & Pancreatic Cancer, Advanced Minimally Invasive & Robotic Surgery offer such experience and knowledge. Call today to schedule a consultation at our office.

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Sharona Ross, M.D. - Tampa Laparoscopic Surgeon
Located at 3000 Medical Park Dr, Suite 500 Tampa, FL 33613. View Map
Phone: (813) 615-7030
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