biliary obstruction


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biliary obstruction

blockage of the common or cystic bile duct, usually caused by one or more gallstones. It impedes bile drainage and produces an inflammatory reaction. Less common causes of biliary obstruction include choledochal cysts, pancreatic and duodenal tumors, Crohn's disease, pancreatitis, echinococcosis, ascariasis, and sclerosing cholangitis. Stones, consisting chiefly of cholesterol, bile pigment, and calcium, may form in the gallbladder and in the hepatic duct in persons of either sex at any age but are more common in middle-aged women. Increased amounts of serum cholesterol in the blood, such as occurs in obesity, diabetes, hypothyroidism, biliary stasis, and inflammation of the biliary system, promote gallstone formation. Cholelithiasis may be asymptomatic until a stone lodges in a biliary duct, but the patient usually has a history of indigestion and discomfort after eating fatty foods. A calculus biliary obstruction should be considered cancerous until proven otherwise.
observations Biliary obstruction is characterized by severe epigastric pain, often radiating to the back and shoulder, nausea, vomiting, and profuse diaphoresis. The dehydrated patient may have chills; fever; jaundice; clay-colored stools; dark, concentrated urine; an electrolyte imbalance; and a tendency to bleed because the absence of bile prevents the synthesis and absorption of fat-soluble vitamin K.
interventions The patient is placed in bed in a semi-Fowler's position and is usually administered intermittent nasogastric suctioning, parenteral fluids with electrolytes and fat-soluble vitamins, and medication for pain. Antibiotics, anticholinergic and antispasmodic drugs, and a cholecystogram or ultrasound scan may be ordered. The blood pressure, temperature, pulse, and respirations are monitored, and the patient is helped to turn, cough, and deep breathe every 2 to 4 hours. Fluid intake and output are measured, and the color and character of urine and stools are noted. When the nasogastric tube is removed, the patient initially receives a low-fat liquid diet and progresses to a soft or normal diet, as tolerated; up to 2500 mL of fluids a day are encouraged or administered intravenously, unless contraindicated. Cholecystectomy is usually the definitive treatment, but in most cases surgery is delayed until the patient's condition is stabilized and any prothrombin deficiency (caused by vitamin K malabsorption) is corrected.
enlarge picture
Stents in place to correct biliary obstruction

biliary obstruction

A blockage of the bile ducts with accumulation of bile in the liver.
 
Clinical findings
Colicky upper right-quadrant pain, jaundice, itching, dark-coloured urine.

Aetiology
Stone, tumour, pancreas (tumours or pancreatitis), cholecystitis, bile duct cysts, trauma, bile duct stricture, enlarged lymph nodes.

biliary obstruction

Bile duct obstruction Clinical medicine A blockage of the bile ducts with accumulation of bile in the liver Etiology Stone, tumor, pancreas–tumors or pancreatitis, cholecystitis, bile duct cysts, trauma, bile duct stricture, enlarged lymph nodes Clinical Colic, jaundice. See Gall bladder disease.

biliary

pertaining to the bile, to the bile ducts, or to the gallbladder. See also bile duct.

biliary excretion
removal in the bile of substances including drugs, toxins, hormones or pigments, or their breakdown products. These are delivered to the duodenum and removed in the feces.
biliary fever
biliary fibrosis
one of the three forms of hepatic fibrosis; largely confined to the portal triads; see also bile duct fibrosis.
biliary infarct
areas of hepatic fibrosis that physically resemble vascular infarcts but are related to damaged bile ducts.
interlobular biliary duct
biliary obstruction
obstruction of biliary ducts may be intra- or extrahepatic, and intraluminal (calculi) or by external compression by tumor mass or cicatricial contraction, or more commonly in food animals by migrating ascarid larvae in the bile ducts or by cholangitis caused by Fasciola hepatica or Dichrocoelium dendriticum. Jaundice is the outstanding clinical sign of the condition. See also cholestasis.
biliary salts
see bile salt.
biliary stones
biliary tract
the organs, ducts, etc., participating in secretion (the liver), storage (the gallbladder, if present), and delivery (hepatic and bile ducts) of bile into the duodenum.
References in periodicals archive ?
Bile acids, oxidative stress and renal function in biliary obstruction Semin Nephro 1997; 17: 549-562.
Patients with extensive biliary involvement (intra-and extrahepatic or isolated intrahepatic strictures) who are unsuitable for a biliary bypass operation can be offered a PSS, which will resolve the biliary obstruction in about 50% of cases.
10 Overall this procedure provides effective relief of obstructive jaundice in benign biliary tract conditions but it is not universally used for malignant biliary obstruction.
The return of alkaline phosphatase to normal following relief of biliary obstruction has been found to be extremely variable.
Conclusion: in elderly patients, common bile duct stones often present atypically and co-existence with malignancy is not unusual; ampullary carcinoma has a relatively good prognosis and ERCP is a safe and effective procedure in the management of biliary obstruction.
Clinical management of malignant biliary obstruction remains challenging.
Renal failure remains an important postoperative problem in surgeries for biliary obstruction.
Both ultrasonography and computed tomography can readily identify extrahepatic biliary obstruction.
Biliary obstruction is common in clinical practice and in most instances is due to biliary stones disease.
Although PTBD and ENBD can relieve biliary obstruction they do not restore bile flow to the duodenum, so the enterohepatic circulation is still disrupted, and impaired intestinal barrier integrity may continue.