Bile Duct Diseases: An Introduction

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Bile ducts are tubes that primarily carry bile from the liver and gallbladder to the small intestine to help digest fats.

Several diseases in the bile ducts can prevent proper bile duct functioning. Read along to find out more.

Bile duct disease

There are several bile duct diseases that can occur. Gallstones are one common issue for bile ducts. These form when deposits of digestive fluid harden in the gallbladder. They can cause inflammation, increasing pressure in the gallbladder and potentially blocking a bile duct. Another common bile duct condition is cholangitis, which is inflammation in the bile duct system. This is often caused by a bacterial infection.

Bile ducts can also have strictures (narrowing). In other cases, they can leak. Cancer can also occur in the bile ducts. Bile duct cancer is rare and aggressive. Additionally, some infants are born with a condition called biliary atresia, in which bile ducts are scarred and blocked. This causes a buildup of bile in the liver and can damage it.

Symptoms of Bile Duct Diseases

Bile duct diseases tend to have some of a group of symptoms. These include abdominal pain, nausea, vomiting, itchy skin, fever, chills, weight loss, loss of appetite, and jaundice. Pain may occur in the upper abdomen and radiate to the back in some cases. Depending on the disease, these symptoms can be at differing levels of severity and present in varied ways. The progression the disease also influences the severity and types of symptoms.

Diagnosis

Doctors diagnose bile duct diseases in a few different ways. Bilirubin blood testing can identify high levels of bilirubin in your bloodstream and can diagnose jaundice. Doctors can perform an Endoscopic Retrograde Cholangiopancreatogram (ERCP) to diagnose diseases. In an ERCP, they can inject contrast dye to help image your bile ducts during an x-ray. They can also perform an Endoscopic Ultrasound (EUS) to examine your bile ducts and make a diagnosis.

Treatment

Treatments vary depending on the type of bile duct disease. ERCP, in addition to helping with diagnosis, can help treat disease. Doctors can pass tools through the endoscope during an ERCP and open blocked ducts, remove or break up gallstones, insert stents, and even remove tumors. Doctors can also help drain bile during an EUS by inserting a stent to help drain into the small intestine or stomach. One other emerging treatment involves using Radiofrequency Ablation for palliative care to treat the symptoms of bile duct cancer. This can be a way to manage pain for long-term cases of cancer.

Surgery may also be necessary in some cases. For example, with patients who have bile duct cancer, surgery can help to remove tumors. If tumors are very large, doctors may need to remove the liver and perform a liver transplant.

Our experienced team at GHP has years of experience treating conditions including bile duct diseases. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.

Endoscopic Ultrasound: How to Prepare

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An Endoscopic Ultrasound (EUS) is a procedure for assessing and producing images of the digestive system with an endoscope. It is also used as a modality to treat certain gastrointestinal disorders through fine-needle aspiration (FNA). Follow along for an overview of EUS. 

When an Endoscopic Ultrasound is used

An EUS can help doctors determine the source of chest pain, abdominal discomfort, and other symptoms. It can also help them evaluate the extent of disease spread in your digestive tract, and evaluate findings from other diagnostics like MRIs or CT scans. It can help evaluate conditions including Barrett’s Esophagus, Lymphoma, and various cancers. 

There are many different therapeutic procedures that can be performed during an EUS. These include celiac plexus neurolysis (EUS-CPN), pseudocyst drainage, biliary drainage (EUS-BD) and liver biopsy. Each of these treatments has a unique set of steps involved. Below, we will take a look at some general steps and approaches involved with the various diagnostics and treatments performed through an Endoscopic Ultrasound. 

Preparing for an EUS

The way you need to prepare for an EUS depends on the specifics of the procedure and any therapeutic treatments in your case. In general, you often need to fast starting the midnight before the procedure. This helps empty your stomach. You may also need to discuss any medications you are taking with your doctor before the procedure. It is especially important to stop taking any blood-thinning medications leading up to the procedure. These medications can increase the risk of severe bleeding during the Endoscopic Ultrasound. If the EUS is being performed in the rectal area, you may need to undergo a cleansing routine to prepare your bowels. This usually consists of taking a liquid laxative and sticking to a liquid diet for a day before the procedure. 

During the procedure

On the day of your Endoscopic Ultrasound procedure, you will first go to a pre-op area where your medical information will be taken and you will be given an IV. You will also discuss sedation used during the procedure with an anaesthesiologist. 

Depending on the location in your GI tract that doctors will examine or treat, they will advance an endoscope through your mouth or a colonoscope through your anus. You will be on your left side and may be sedated as this happens. Your doctor will advance the scope to the site or sites of interest and then perform any diagnostics or treatments. This can include tissue biopsies, pain-relieving injections, pseudocyst drainage, and bile duct drainage, depending on your situation. Your doctor will be able to see your GI tract through a camera at the end of the scope, and will pass any necessary instruments through the scope to perform the procedure. Most EUS examinations take under an hour, but the exact time will vary depending on what diagnostics or treatments your doctor is administering. 

After an Endoscopic Ultrasound

After your procedure, you will go to a post-op area where you will recover from any sedation and be monitored for side effects of the procedure. Once you are recovered, your doctor will share results with you. Some biopsy results may take longer to return. Given sedation side effects, you should not operate machinery, drive, or make important decisions for 24 hours following the procedure. 

Endoscopic Ultrasounds have a relatively low risk for complications. If you underwent Celiac Plexus Neurolysis to provide pain relief for tumors, you may experience abdominal pain for a few hours and diarrhea for a few days. More rarely, bleeding, infection, and paralysis can occur. If you underwent Pseudocyst Drainage, there is a small risk of bleeding, infection, and pancreatitis. Additionally, in under one percent of cases, perforations occur, requiring surgery to repair. If you underwent Biliary Drainage, there is a 10-20% chance of mild complications associated with bile drainage. These include bleeding, infection, and bile leakage in the abdominal cavity. If you underwent a Liver Biopsy, complications are very rare, and include a small risk of bleeding and infection. In general, if you were sedated during your procedure, there are a few uncommon complications including aspiration, adverse reactions to sedative medication, and complications from lung and heart diseases. 

Our experienced team at GHP has years of experience performing Endoscopic Ultrasounds. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and schedule an appointment today.