Bile duct disease

What is bile duct disease?

The bile ducts are a system of tubes that collect bile from the liver and allow it to drain into the gut. They start in the liver, joining up to form the large main bile duct. 

The gallbladder, a pear-shaped sack under the liver which stores bile, also connects to the main bile duct. A number of conditions can affect the bile ducts. These can include:

•    Gallstones
•    Blockages of the bile duct
•    Inflammation of the bile ducts

If you have a problem with your bile ducts, or have symptoms that suggest you might, our specialists at the London Liver Group operate as teams of experts with world-class resources to ensure you get the care you need.

Causes

Gallstones 
Gallstones are the most common condition affecting the gallbladder or bile ducts. These stones are formed from some of the chemicals found in the bile. 

There are many risk factors for developing gallstones, including being overweight, aged over 40, female, or having a family history of having gallstones

Bile duct blockages
There are a number of causes of a stricture (narrowing) in the bile duct. 

It can be due to inflammation around the bile duct, or a mass such as bile duct cancer or cancer of the head of the pancreas.

Cholangiopathies
These are widespread diseases of the bile duct system such as primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). 

They can cause pain, jaundice and liver damage.

Symptoms

You may already have gallstones and not even know it, as the majority of patients have no symptoms. 

Occasionally a gallstone can become trapped in a duct, causing sudden severe pain. This is called biliary colic. Gallstones can also lead to infection of the gallbladder (cholecystitis) or of the bile ducts (cholangitis).

Complete obstruction of the bile duct can cause severe pain, jaundice (yellowing of the skin and eyes), and occasionally inflammation of the pancreas (acute pancreatitis).

The cholangiopathies can cause pain, fever from infection, and liver problems with jaundice and itching.

Diagnosis

In order to diagnose the cause of your symptoms, your specialist from the London Liver Group will first ask about all your symptoms in detail and about any medical problems you might have. 

They will then examine you, including feeling your abdomen. Your specialist may recommend blood tests to check the function of your liver and look for signs of infection.

Further investigations will be guided by what your specialist finds. Test can include:

•    Ultrasound scans – often used to diagnose gallstones
•    Endoscopic retrograde cholangio-pancreatography (ERCP) – a dye that shows up on X-Rays is injected into the biliary tree during an endoscopy
•    CT scan – often to look for complications or spread of disease
•    MRI scan – can look for gallstones in the bile ducts

Your specialist will keep you informed of your results at every stage and work with you to create a plan that fits you.

Treatments

The treatment for biliary duct conditions is guided by the cause of the problem. For gallstones in the gallbladder that are causing symptoms, often the best course of action is to remove the gallbladder during keyhole surgery. 

This is called a laparoscopic cholecystectomy. Gallstones that are stuck in the biliary duct can be removed during an ERCP. Blockages of the biliary duct can often be bypassed by placing a small metal tube through them during an endoscopy. 

This allows the bile to flow out, but does not treat the underlying cause of the blockage. The cholangiopathies may be managed with oral medication, although more advanced disease may need other treatments.