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Biliary obstruction results in the weakening or complete inhibition of bile transport to the gastrointestinal tract. There may be various reasons for this. What is the diagnosis of biliary obstruction? How to treat biliary obstruction?

The bile ductsare responsible for the flow of bile from the liver to the duodenum. The bile ducts can be divided into intrahepatic and extrahepatic. The intrahepatic tracts include bile ducts, interlobular conductors, bile ducts, right and left hepatic ducts.

The extrahepatic bile ducts are the common hepatic duct, gall bladder, cystic duct, common bile duct.Bile is produced in the liverand is involved in the digestion and absorption of fats. The obstruction of the biliary tract results in the weakening or complete inhibition of bile transport to the gastrointestinal tract.

Biliary obstruction - causes

There are many causes of biliary obstruction. They are associated with both biliary and liver disorders. The most common causes of biliary obstruction are:

  • cholelithiasis - the presence of deposits in the bile within the gallbladder (choledocholithiasis) or in the intrahepatic and intrahepatic bile ducts (choledocholithiasis);
  • gallbladder cancer - the risk factors for this cancer include many years of gallstone disease;
  • biliary tract cancer - is divided into intrahepatic and extrahepatic carcinoma and comes from the epithelium lining these mucosal pathways;
  • cancer of the nipple Vater - it arises at the junction of the bile ducts with the duodenum;
  • pancreatic cancer - a very malignant neoplasm, rapidly growing in size;
  • liver tumors - tumors formed in the liver can put pressure on the bile ducts, causing their lumen to close;
  • cirrhosis of the liver - fibrosis of the liver parenchyma and the formation of regenerative nodules may cause obstruction of the lumen of the bile ducts;
  • acute cholangitis - occurs as a result of an infection as a result of obstructed bile flow;
  • primary sclerosing cholangitis - a chronic disease of the liver in the course of which it occursdamaging the bile ducts;
  • damage to the bile ducts as a result of trauma and postoperative damage;
  • other less common diseases: eosinophilic cholangitis, atrophic biliary tract syndrome, Alagille syndrome.

    Biliary obstruction - symptoms

    The dominant symptom of inhibition of bile outflow is jaundice, i.e. yellow discoloration of the skin, mucous membranes and sclera caused by the accumulation of bilirubin in the tissues. It also causes excessive itching of the skin, discoloration of stools and dark urine. Other symptoms that may occur as a result of biliary obstruction are:

    • chronic fatigue;
    • pain in the area of ​​the right hypochondrium;
    • nausea and vomiting;
    • weight loss.

      Biliary obstruction - diagnosis

      Biliary obstruction is diagnosed on the basis of research. The basic test is a laboratory test of blood that shows elevated bilirubin levels, it may also show an increase in the activity of enzymes such as alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), alanine amyltransferase (ALT).

      The urine test can also detect the presence of bilirubin in the body. Other tests that diagnose obstruction of the bile ducts include ultrasound of the abdominal cavity - it shows the image of the liver and bile ducts. It can visualize deposits within the bile ducts, but more often it shows only their width. Dilation of the bile ducts indicates a cause outside the liver, while if the ducts are not dilated, it is necessary to look for diseases in the liver.

      Computed tomography is also used to diagnose biliary obstruction, which allows for a more detailed examination. Tomography is useful in detecting complications.

      Other tests used for diagnostics are:

      • magnetic resonance imaging cholangiopancreatography (MRCP) - allows for a more detailed examination of the bile ducts and the recognition of characteristic changes within them;
      • endoscopic retrograde pancreatography (ERCP) - is an invasive test that is used when MRCP is insufficient to make a diagnosis. It enables the collection of material for cytological examination, it is also used in treatment;
      • liver biopsy - performed when other diagnoses are not completely certain.

        Biliary obstruction - treatment

        The treatment used in biliary obstruction is dependent onthe reasons for this state.

        In the case of cholelithiasis, laparoscopic cholecystectomy or open cholecystectomy is used. Pharmacological therapy is also possible, involving the administration of ursodeoxycholic acid preparations.

        Dural stones are treated with ERCP with sphicterotomy, during which the deposits are removed into the duodenum with a balloon. Extracorporeal lithotripsy with shockwave and cholecystectomy are also useful.

        Acute cholecystitis requires a strict diet limiting the intake of fatty foods. Antibiotics are given and a cholecystectomy may be necessary.

        In acute cholangitis, a strict diet and an antibiotic are also introduced. Deposits are removed by ERCP with sphincterotomy or subcutaneous drainage under computed tomography or ultrasound guidance.

        Primary sclerosing cholangitis is treated pharmacologically with ursodeoxycholic acid preparations or endoscopically by balloon dilation or biliary prosthesis.

        Treatment for cancer varies, and may require an organ excision, chemotherapy and radiation therapy.

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