Uncleared Bile Duct Blockage

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Uncleared Bile Duct Blockage

Question:

If a bile duct blockage is not cleared, what will happen?

Answer:

If a bile duct blockage is not cleared, bile will be unable to flow from the liver (and gall bladder) into the intestine. One of the major components of bile is bilirubin, a yellow pigment derived from hemoglobin once it is released from dying red blood cells. Because the bilirubin cannot be excreted by the liver, it accumulates in the body.

This will cause yellowing of the skin and eyes. Urine will darken and stool will become pale because of blocked bilirubin excretion.

More vexing will be the development of generalized itching, presumed to be due to the retention of chemicals, possibly bile acids, which irritate the skin. The itching can be extremely intense and unrelenting. Because bile acids help digest fat, their failure to reach the intestine will result in the poor absorption of fat, usually to a mild degree. If this continues, it can result in poor vitamin D uptake by the intestines, causing weakening of the bones.

Anytime a normal drainage pathway of the body becomes blocked the stage is set for infection of the secretions and tissues behind the blockage. This becomes a more likely possibility in the case of bile duct blockage if dilating instruments are used in an attempt to relieve the blockage. These instruments tend to introduce bacteria, which will multiply if the blockage remains unopened. The end result can be an infection of the bile ducts and liver, known as ascending cholangitis.

So, it is important to relieve bile duct obstruction when it occurs. Surgery is not always required; many obstructions can be unblocked by skilled endoscopists, or even widened with catheters inserted through the liver by radiologists who can guide them in place using imaging techniques.

Stephen Goldfinger, M.D., is a professor of medicine at Harvard Medical School. He is a graduate of Columbia College of Physicians and Surgeons, and his clinical base is at the Massachusetts General Hospital.

Last updated:	July 20, 2009