Clinical
features: The most common feature of obstruction to the common bile duct is jaundice. It is associated with moderate pain and fever. The liver may get palpably enlarged. The gall bladder gets enlarged and is tense in obstructive jaundice due to carcinoma, but is contracted in obstruction due gall stones. There is usually itching all over the body, due to accumulation of bile salts in the blood. If the bile ducts
get infected the condition is called cholangitis, which is life threatening and is manifested by high grade fever associated with chills and rigors.
Diagnosis:
There is an increase in serum bilirubin. There will be elevation of serum levels of hepatic enzymes like SGOT and SGPT(ALT). In addition the levels of alkaline phosphatase increase in bile duct obstruction. Ultrasound scanning shows dilatation of the bile ducts and presence of gall stones in the bile ducts and gall bladder. Tumors may be visualised by CT scan. ERCP shows the pathology very
clearly. . Here a gastroscope is passed to the duodenum through the stomach, the bile ducts are canulated and a radio opaque dye is injected into the bile ducts and pancreatic duct. This
modality is also useful in treating the obstruction.
Treatment: The only treatment for stones in the common bile duct is removal of the stones from the bile ducts. This can be done either by open surgery or ERCP. In ERCP procedure sphincterotomy is done. Smaller stones are left to be passed spontaneously or a wire basket is introduced into the common bile duct and the stone is extracted. In severely ill patients a stent is passed into the common bile duct to drain the biliary tree and tide over the crisis. Most of these patients require a cholecystectomy later. If the obstruction is due to cancer the treatment depends on the site of cancer. Surgery is done to assess the site and type of cancer and removal is attempted if possible . Distressing symptoms like pain, jaundice and itching may be relieved by passing a stent into the common bile duct through an endoscope.