Bile is a liquid secreted by the liver that contains cholesterol, 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 fat digestion.

When an obstruction occurs in the bile ducts, bile accumulates in the liver, and jaundice (yellow color of the skin) develops due to the accumulation of bilirubin in the blood.

Causes of obstruction include the following:

• Gallstones
• Tumors of the bile ducts or pancreas
• Other tumors that have spread to the biliary system
• Trauma including injury from gallbladder surgery
• Choledochal cysts
• Enlarged nodes in the porta hepatis
• Inflammation of the bile ducts

Risk factors include the following:

• History of any of these conditions:
  • Cholelithiasis (gallstones)
  • Chronic pancreatitis
  • Pancreatic cancer
• Recent biliary surgery
• Recent biliary cancer (such as bile duct cancer)
• Abdominal trauma.

In immunosuppressed patients, obstructions can be caused by infections.

• Pale-colored stools (caused by lack of bilirubin)
• Dark urine (caused by bilirubin excreted in the urine)
• Jaundice (yellow skin color)
• Itching
• Abdominal pain in the upper right quadrant
• Fever
• Nausea and vomiting

• Bilirubin is elevated.
• Alkaline phosphatase is elevated.
• Liver enzymes are elevated.

• Abdominal ultrasound
• Abdominal CT scan
• ERCP (endoscopic retrograde cholangiopancreatography)
• Percutaneous transhepatic cholangiogram (PTCA)
• Magnetic resonance cholangiopancreatography (MRCP)

• Gallbladder radionuclide scan
• Urine bilirubin
• Amylase

The objective of treatment is to relieve the blockage. Stones may be removed using an endoscope during an ERCP. In some cases, surgery is required to bypass the obstruction. The gallbladder will usually be surgically removed if the biliary obstruction is caused by gallstones. Your health care provider will prescribe antibiotics for biliary obstruction if infection is suspected.

In blockage caused by cancer, endoscopic (using an endoscope) or percutaneous (through the skin) dilation of the obstruction and placement of a tube for drainage may be required.