The bile ducts are small channels within the gallbladder and liver that secrete bile into the duodenum (small intestine) to aid in digestion. Bile is comprised of cholesterol, salts, acids and some waste products that help the body absorb fats and vitamins. The pancreas also secretes digestive enzymes into the duodenum through the pancreatic duct. This ductal system of the gallbladder, liver and pancreas makes up the pancreaticobiliary tract, often called the biliary tract, biliary system or biliary tree.
Ducts can become blocked with stones, form strictures or scar tissue, or become narrowed from infection, inflammation or cancer. In infants, the bile ducts may fail to form properly, a condition called biliary atresia. This condition is treated with surgery, using part of the newborn's intestine to form bile ducts or to reroute the drainage of bile through the intestine. Virginia Mason treats many bile duct disorders with state-of-the-art and novel therapies. For more information or to schedule an appointment, call (206) 223-2319.
Symptoms of Bile Duct Disorders
Disorders of the bile duct oftentimes have the same symptoms because most of them block the ducts from releasing bile or digestive enzymes into the small intestine. Symptoms may develop suddenly, as when a gallstone blocks the cystic duct within the gallbladder, or may occur over several years as scar tissue develops. Common symptoms and signs of bile duct disease include:
- Yellow skin or eyes (from the build up of bilirubin, a waste product)
- Weight loss
- Night sweats
- Loss of appetite
- Abdominal pain on the right side of the body (where the liver and gallbladder are located)
- Greasy or light-colored stools
Diagnosing Disorders of the Bile Ducts
Your gastroenterologist may suspect a bile duct disorder based on your appearance, a description of your symptoms, and whether a blood test shows high levels of bilirubin, a waste product in blood from the normal breakdown of red blood cells. A definitive diagnosis is made through a procedure called ERCP, or endoscopic retrograde cholangiopancreatography.
- BLOOD TESTS
In addition to a bilirubin test, your blood may be tested for the presence of elevated white blood cells used by the body to fight infection, and for abnormal levels of pancreatic and liver enzymes. Other blood tests may be performed to rule out liver disorders, such as cirrhosis or cancer.
- ABDOMINAL ULTRASOUND
This non-invasive procedure uses sound waves rather than x-rays to produce images. The images can reveal a narrowing within the common bile duct. During this procedure, an ultrasound probe is passed over the abdomen and images are sent to a computer monitor. Abdominal ultrasound is commonly used in women who are pregnant.
- ABDOMINAL CT SCAN OR MRI A CT scan of the abdomen or an MRI can identify narrowing within the biliary tract. Both are noninvasive procedures. During these scans, images are shown on a computer monitor.
Magnetic resonance cholangiopancreatography (MRCP) is performed in Radiology using MRI technology (magnets and radio waves) to produce computer images of the gallbladder, pancreas and bile ducts. A contrast dye is injected first into a vein to enhance the images. Patients are not required to undergo endoscopy preparation and they do not undergo sedation. MRCP is being used primarily in patients who may have failed or who are not good candidates for ERCP, in those who do not want to undergo an endoscopic procedure, and in individuals considered to be at low risk of having a pancreatic duct or bile duct disorder. While ERCP allows for therapeutic options with cholangioscopy, MRCP is a diagnostic tool only.
Virginia Mason also is involved in national clinical trials to determine the accuracy of MRCP in diagnosing disorders of the biliary tract.
- ERCP AND/OR EUS
Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialized endoscopic technique used to study the gallbladder, pancreas and bile ducts, and has the added benefit of being a therapeutic tool. ERCP has been in use for more than 40 years, and is considered the standard modality for diagnosing and treating disorders of the biliary tract.
During this procedure, and after first receiving a sedative and an anesthetic to numb the throat, an endoscope containing a miniature camera is passed down your esophagus and into the biliary tract. When your gastroenterologist sees the biliary and pancreatic ducts, he or she then passes a catheter (a narrow plastic tube) containing a contrast dye through the endoscope. The dye is injected into the pancreatic and biliary ducts and x-rays are taken that are viewed on a computer monitor. The procedure takes 60-90 minutes and is performed in the Endoscopy Suite within Virginia Mason's Section of Gastroenterology and Hepatology.
Your gastroenterologist can pass a thin ultrasound probe through the ERCP endoscope. Alternatively, endoscopic ultrasound, or EUS, which uses ultrasound images in place of x-rays for better viewing of the bile and pancreatic ducts can be done with a specially designed endoscope.
Your gastroenterologist can treat a bile duct disorder at the same time it is being diagnosed by passing a cholangioscope, a type of endoscope holding specialized instruments, through the ERCP endoscope. This treatment, called cholangioscopy, allows your physician to view, diagnose and treat gallbladder and bile duct stones, bile duct strictures and sclerosing cholangitis.
Special preparations are required for this endoscopic procedure. Please see the ERCP and EUS prep planners for more information.
- PERCUTANEOUS TRANSHEPATIC CHOLANGIOGRAM
This procedure, performed by a radiologist, is an x-ray of the bile ducts inside and outside of the liver, and shows drainage of bile from the liver. After first receiving a local anesthetic, a long, thin needle is inserted through the abdominal skin (percutaneously) and into the liver. The needle injects a contrast dye near the ducts to be studied and images are shown on a fluoroscopic monitor. The images can reveal whether the bile ducts are enlarged, indicating that a stricture or stone may be blocking the duct.
Treating Disorders of the Bile Ducts
The majority of disorders of the biliary system are treated at Virginia Mason with minimally invasive endoscopic technology. The benefit for patients is a shorter procedure and quicker return to daily activities than would be the case with traditional open surgery in the operating room.
Many biliary tract disorders are treated at the time of diagnosis with a cholangioscope, holding specialized instruments, inserted through the ERCP endoscope. Common biliary tract disorders treated with this technology include gallbladder and bile duct stones, bile duct strictures and sclerosing cholangitis.