Most of the time we are unaware of our body’s biliary system and the integral role it plays in digestion and maintaining our overall health. A blockage of the biliary tree – a branched system of ducts that conveys bile from the liver to the gastrointestinal system ¬– can quickly progress to a life threatening emergency.
Dr Zain Ally, a hepatobiliary surgeon sub-specialised in hepatobiliary and gastrointestinal surgery who practises at Netcare Sunninghill Hospital, shares what everyone should know about obstructive jaundice, the underlying conditions that may cause this, the potential complications, and the treatments available.
“Bile contains cholesterol and metabolites, which are necessary for the digestion of food, and is produced in the liver in response to the fat content of the meal. Bile also helps rid the body of toxins and the waste products of metabolism,” Dr Ally explains.
“In its journey from the liver, through the biliary tree, to the small intestine, bile passes through the head of the pancreas, which surrounds the bile duct. Excess bile is forced back through the system of ducts and stored in the gallbladder, until the next meal when it is needed in the gastrointestinal system.
A blockage in the biliary system prevents the flow of bile and, if it is not resolved, leads to obstructive jaundice. Such blockages are most commonly caused by gallstones or cancer,” he says.
Symptoms of obstructive jaundice include yellowing of the sclera (the white part of the eye) and of the skin, itching, bruising easily, as well as passing pale stools and dark urine.
A gallstone is formed from the cholesterol in bile. Over time excess cholesterol can solidify into small crystals which bind together to form a gallstone.
“There are many different symptoms associated with gallstones, the most common being a colicky pain – a sharp localized pain in the abdomen that may come in spasms – soon after a meal, as muscular contractions work to clear the temporary blockage of the gallbladder outflow duct.
“Usually, the pain abates after a few hours, however if the body cannot clear the blockage immediately, the obstruction within the gallbladder prevents it from fully empying the contents of the gallbladder. This in turn leads to stasis, infection of the gallbladder, and possibly a perforation or rupture. The person would be likely to experience a persistent, severe upper abdominal pain that is worsened by movement, touch or even deep breathing.
“If the obstructing gallstone is passed from the gallbladder and instead blocks the outflow of the biliary tree, this results in obstructive jaundice. Various organ systems are affected and this too can be extremely serious as the kidneys, brain, blood and cardiovascular system are all affected by obstructive jaundice,” Dr Ally adds.
“Whether caused by a gallstone or cancer, a blockage of the biliary tree can quickly lead to secondary infection, potentially causing organ failure and death within hours if it is not treated immediately.”
Ten risk factors for gallstones
- Women are more prone to developing gallstones, although men can also be affected
- The risk of gallstones increases with age, particularly from 40 onwards
- Genetic factors can predispose a person to gallstones, find out if any of your direct relatives have had gallstones
- Being overweight
- A sedentary lifestyle
- A diet high in fat
- Frequent fasting
- Rapid weight loss
- Diabetics are also at increased risk of developing gallstones
“The probability of cancer causing obstructive jaundice through blocking in the biliary tree or in the head of the pancreas increases in the elderly, and may start slowly and painlessly. Unfortunately, cancers that originate in this part of the body are often only detected at a more advanced stage and therefore a suspicion of cancer should be investigated as soon as possible,” cautions Dr Ally.
Modern technology and ever advancing surgical techniques are improving the prognoses for patients with cancer in the liver, biliary tree and pancreas. Surgery is often done in combination with chemotherapy, however the earlier these conditions are diagnosed the better.
“Today, gallstones in the gallbladder can be treated with minimally invasive keyhole surgery to remove the gallbladder. However, up to one in four patients who have gallstones in their gallbladder will have additional stones that have formed outside of the gallbladder, requiring a different treatment approach,” Dr Ally says.
Hepatobiliary surgeons, such as Dr Ally, are trained in the management of complicated biliary, pancreatic and liver diseases and can access the biliary tree to remove any gallstones lodged there. This is done by means of an endoscopic retrograde cholangiopancreatography (ERCP) procedure.
“In an ERCP, a long thin tube is carefully guided to the biliary tree to remove the gallstones to be removed, and insert stents in the areas where the gallstones were removed to restore bile flow. This makes it possible for healthy biliary and organ function to resume,” he explains.
Such procedures are best performed by a team including a hepatobiliary surgeon in facilities, such as Netcare Sunninghill Hospital, that are equipped for complex radiological investigations and advanced surgical technology.
“Time is critical in treating a person with a blockage of the biliary tree. Knowing the symptoms of obstructive jaundice and recognising this as a medical emergency can help to save lives,” Dr Ally concludes.
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