What Is a Biliary Obstruction?

Obstruction of biliary tract refers to the mechanical obstruction of bile ducts caused by poor bile excretion or even complete blockage in any part of the bile duct due to diseases in the bile duct, internal diseases of the tube wall, and infiltration and compression outside the tube wall. It is manifested as jaundice, accompanied by epigastric pain, chills and fever. The nature of abdominal pain is mainly bloating and colic, and sometimes colic is a significant symptom. There is a history of recurrent episodes. Generally, it is acute and subacute. Treatment should pay attention to changes in liver function.

Basic Information

English name

biliary tract obstruction

Visiting department

Gastroenterology, General Surgery

Common locations

bile duct

Common causes

Bile duct stones, biliary ascariasis, bile duct stenosis, bile duct tumors, etc.

Common symptoms

Abdominal cramps, jaundice

Causes and common diseases of biliary obstruction

Biliary obstruction is a disease with a high mortality rate in surgical acute abdomen, most of which are secondary to bile duct stones and biliary ascariasis. But bile duct stenosis and bile duct tumors can also be secondary to this disease. These diseases cause obstruction of the bile ducts, cholestasis, and secondary bacterial infections. Almost all pathogenic bacteria come from the intestine and enter the biliary tract retrogradely through the channels of the ampulla or bile-enteric anastomosis. Bacteria can also enter the biliary tract through the bloodstream or lymphatic channels. The pathogenic bacteria are mainly Escherichia coli, Klebsiella, Streptococcus faecalis and certain anaerobic bacteria.

On the basis of the original obstructive diseases such as calculi, bile duct infection occurs, the bile duct mucosa is congested with water, and the obstruction of the bile duct is aggravated. The bile gradually becomes purulent, the pressure in the bile duct increases continuously, and the bile duct near the obstruction gradually expands. Under the action of bile duct hypertension with purulent bile, the liver can swell, and the small bile ducts in the liver and surrounding parenchymal cells can also undergo inflammatory changes. Liver cells produce large necrosis, which can form multiple small abscesses in the liver. Bile ducts can also cause ulcers and biliary tract bleeding due to infection and purulent infections. Due to the intrahepatic capillary bile duct rupture caused by high pressure in the bile duct, purulent bile and even bile plugs enter the blood circulation through the intrahepatic blood sinus, causing bacteremia and sepsis. Few pulmonary embolisms can also occur. In the later stage, a series of pathophysiological changes such as septic shock, liver and kidney failure, or diffuse intravascular coagulation can occur, which is acute obstructive suppurative cholangitis or acute severe cholangitis. Once these pathological changes occur, even if the bile duct hypertension is removed by surgery, there will still be damage in the liver parenchyma and bile ducts.

Differential diagnosis of biliary obstruction

The diseases that cause obstructive jaundice are broadly divided into two categories, benign and malignant.

Benign disease

Bile duct stones are the most common, followed by biliary inflammatory stenosis (such as duodenal papillary stenosis, acute and chronic cholangitis, etc.), and benign bile duct tumors (such as common bile duct cysts, etc.). The occurrence of these benign lesions jaundice is accompanied by prominent epigastric pain, chills and fever. The nature of abdominal pain is mainly bloating and colic, and sometimes colic is a significant symptom. Previous recurrent episodes are generally acute. And subacute symptoms appear.

Malignant disease

Including a variety of primary and metastatic cancers that occur in the common bile duct, common bile duct cancer, pancreatic head cancer, duodenal papillary cancer, and so on. The pathological changes of malignant tumors are usually a chronic process, which is painless jaundice, which does not attract patients' attention. They often seek medical treatment very late, most of which are about 1 to 2 months. The accompanying symptoms are usually atypical. Pancreatic head cancer is often highlighted by right upper quadrant pain. Symptoms, but the pain is lighter, and it is usually dominated by faint pain and dull pain, while bile duct cancer is mainly caused by abdominal distension, indigestion, and decreased appetite. Duodenal papillary cancer can be digested in the early stages of melena and anemia. The main symptoms of tract bleeding. These non-specific symptoms do not pay attention to patients, but also mislead the doctor's diagnosis, thereby delaying the disease, should be taken as a warning. In addition, rare bile duct stones cause obstructive jaundice (Mirizzi syndrome) by compressing the common bile duct.

Biliary obstruction

Common tests for biliary obstruction:

1. Percutaneous transhepatic cholangiography;

2. Choledochoscopy;

3. Intravenous cholangiography;

4. Biliary angiography;

5. Electrocardiogram.

Biliary obstruction treatment principles

It is generally used for antispasmodic analgesic anti-infective treatment, and surgical treatment if necessary. Pay attention to the following situations:

1. Pay attention to liver function changes

AFC often causes severe damage to liver function. Current monitoring methods have not been able to detect liver failure early, and diagnosis is usually made after the occurrence of mental symptoms and hepatic encephalopathy. Therefore, it is necessary to attach great importance to various traits and accurately record daily bile volume and color. , Concentration, etc. Due to damage to liver cells and capillary bile ducts, bile secretion and reabsorption are affected. Sometimes the amount of bile is as high as 4000-7000ml per day. The color is light, which can cause a large amount of water and electrolyte loss, and further increase the burden on the liver. Somatostatin can significantly reduce bile secretion. After bile duct drainage, the intestinal bile salts are significantly reduced, which can not effectively inhibit bacterial reproduction and endotoxins. A large amount of endotoxins pass through the portal vein into the liver, which can further aggravate liver damage. Oral bile salts can significantly reduce intestinal bacteria and Endotoxin. Strengthening intestinal sterilization and cleaning is also very important. Kanamycin can inhibit intestinal bacteria and significantly reduce the amount of endotoxin in the liver.

2. Prevent kidney failure

Kidney damage is often caused by infections, poisoning, dehydration, electrolyte imbalances, and hyperbilirubinemia. The kidney does not have a large reserve power. Once failure occurs, treatment is also difficult. Therefore, attention should be paid to the prevention of renal failure and the monitoring of the kidney. Diuretics should be discontinued at the same time that the fluid is fully replenished to facilitate the elimination of toxic substances and to "flush" the bile plugs deposited in the renal tubules. When oliguria or anuria, large doses of furosemide (fast urine) (400-500mg / d), phentolamine (benzylamine oxazoline), propranolol (propranolol) should be given, and small amounts The pump continuously pumps dopamine intravenously. In the polyuria period, more attention should be paid to the rational use of diuretics, the dose should be gradually reduced, and the loss of water and electrolytes should be added in time.

3. Prevention of respiratory failure

There are no simple and easy-to-see clinical indicators for early respiratory failure. Once the symptoms are obvious, pulmonary dysfunction is in an irreversible state, and effective treatment measures are often lacking. If necessary, continuous positive pressure breathing (PEEP) from the respiratory tract can be used to increase the oxygen supply to the tissue.