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Bile Duct

Dr Thng Yongxian

Hepatopancreatobiliary & General Surgeon
MBBS • MMed • MRCS (IRE) • FRCSED • FAMS

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What Is Bile Duct?

The bile duct is an important component of the human body’s digestive system. It serves as a channel through which bile, a yellow-green fluid produced by the liver, is transported to the small intestine. Bile plays an essential role in digesting and absorbing fats and fat-soluble vitamins from the food we consume.

The structure of the bile duct system is intricately designed to facilitate the efficient transport and storage of bile.

Structure and Function of the Bile Duct

  • Hepatic Ducts
    Originating in the liver, the hepatic ducts collect bile from the liver cells. The liver’s bile ducts converge to form the left and right hepatic ducts, which merge to create the common hepatic duct. This duct transports bile from the liver towards the gallbladder and small intestine.
  • Gallbladder and Cystic Duct
    The gallbladder is a small organ located beneath the liver. It functions as a reservoir for bile. The cystic duct connects the gallbladder to the common hepatic duct. When bile is not needed for digestion, it is stored in the gallbladder through the cystic duct.
  • Common Bile Duct
    The common bile duct is formed by the union of the common hepatic duct and the cystic duct. It is a pathway through which bile flows from the liver and gallbladder to the small intestine. The common bile duct empties into the small intestine at the duodenum.

Bile Duct Disorders

Bile duct disorders encompass a variety of conditions that can affect the normal functioning of the bile duct system.

  • Cholestasis
    Cholestasis occurs when the bile flow from the liver is reduced or blocked. This can happen within or outside the liver. Causes may include liver diseases, bile duct obstructions, or genetic conditions.
  • Gallstones
    Gallstones are solid particles that form in the gallbladder from bile cholesterol and bilirubin. When gallstones block the bile ducts, they can cause acute pain, inflammation, and infections such as cholecystitis. Gallstones can also migrate to the common bile duct, leading to more severe blockages.
  • Primary Sclerosing Cholangitis (PSC)
    PSC is a chronic liver disease characterised by inflammation and scarring of the bile ducts, leading to their narrowing and obstruction. The cause of PSC is unknown, though it is often associated with autoimmune disorders. PSC gradually damages the liver and can lead to liver failure.
  • Bile Duct Cancer (Cholangiocarcinoma)
    Cholangiocarcinoma is an aggressive form of cancer that originates in the cells of the bile ducts. It is often diagnosed at an advanced stage due to its subtle early symptoms, which can include jaundice, weight loss, and abdominal pain.

Diagnosis

Diagnosing bile duct disorders involves a combination of clinical evaluation, laboratory testing, and imaging techniques.

Clinical Evaluation

The diagnostic process begins with a thorough clinical evaluation, including a detailed medical history and physical examination. Healthcare professionals will assess symptoms, previous health conditions, and risk factors associated with bile duct disorders.

Laboratory Tests

Liver function tests (LFTs) can detect elevated levels of liver enzymes, bilirubin, and other substances indicative of liver or bile duct dysfunction. Additional tests may include:

  • Bilirubin tests: These tests are used to measure the levels of bilirubin in the blood, a substance produced by the liver and excreted in bile.
  • Alkaline phosphatase (ALP): Elevated levels of this may suggest bile duct obstruction or liver injury.

Imaging Studies

Imaging studies are critical for visualising the structure of the bile ducts and identifying blockages, narrowing, or other abnormalities. Common imaging modalities include:

  • Ultrasound: A non-invasive test that uses sound waves to create images of the bile ducts, liver, and gallbladder.
  • Magnetic Resonance Imaging (MRI) and Magnetic Resonance Cholangiopancreatography (MRCP): These techniques provide detailed images of the bile ducts, liver, and pancreas.
  • Computed Tomography (CT) Scan: This offers cross-sectional images of the abdomen, which help detect tumours, inflammation, or other abnormalities in the bile ducts.

Biopsy

In cases where cancer is suspected, a biopsy may be performed to obtain a small sample of tissue from the bile duct for microscopic examination.

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Treatment Options

The treatment of bile duct disorders varies significantly depending on the type and severity of the condition.

Medical Management

For conditions like mild cholestasis or specific forms of hepatitis affecting the bile ducts, medical treatment may include:

  • Medications: Ursodeoxycholic acid to improve bile flow, antibiotics for infections, or corticosteroids for inflammatory conditions.
  • Vitamin Supplements: To address deficiencies in fat-soluble vitamins due to malabsorption.

Endoscopic Procedures

Endoscopic techniques are commonly used to diagnose and treat bile duct disorders, especially for removing blockages or relieving strictures:

  • Endoscopic Retrograde Cholangiopancreatography (ERCP): Allows for the removal of gallstones, the insertion of stents to bypass obstructions, or the dilation of narrowed ducts.
  • Cholangiography (PTC): A technique used to image bile ducts or to facilitate drainage or stent placements in cases where ERCP is not feasible.

Surgical Treatment

Surgery may be necessary for more severe or complex bile duct disorders.

  • Cholecystectomy: The surgical removal of the gallbladder, often performed when gallstones cause recurrent problems.
  • Biliary Bypass: Bypassing blocked areas of the bile duct to restore bile flow into the intestine.
  • Liver Resection: Removing a portion of the liver affected by cancer or severe disease.
  • Liver Transplantation: Considered for patients with end-stage liver disease or inoperable bile duct cancer.

Treatment decisions for bile duct disorders are highly individualised, considering the specific diagnosis, the extent of the disease, and the patient’s overall health.

Dr Thng Yongxian

Senior Consultant

HEPATOPANCREATOBILIARY & GENERAL SURGEON

MBBS (SG) • MMed (Surg) • MRCS (Ire) • FRCSEd (Gen) • FAMS (Surg)

Dr Thng Yongxian is a dual fellowship-trained Hepatopancreatobiliary & General Surgeon who has performed over 6000 surgical procedures.

  • Bachelor of Medicine & Bachelor of Surgery
  • National University of Singapore
  • Membership of the Royal College of Surgeons, Ireland
  • Master of Medicine, General Surgery, Singapore
  • Fellow of the Royal College of Surgeons, Edinburgh
  • Fellow of the Academy of Medicine, Singapore

He pursued his subspecialty training in Hepatopancreatobiliary surgery first in the Department of Hepatopancreatobiliary Surgery, Singapore General Hospital. Following this, he completed a clinical fellowship in Minimally Invasive Hepatopancreatobiliary Surgery at Seoul National University Hospital in Bundang, South Korea.


Dr Thng set up and pioneered the Minimally invasive surgery program for his hospital in complex liver and pancreas cases. His surgeries were featured on live national television. His surgical videos have also been presented at international surgical conferences. He also pioneered the use of capsule colonoscopy for colorectal screening.


Dr Thng has served on various committees at hospital, cluster and ministry level. Dr Thng served as a member of the Ministry of Health (MOH) Laparoscopic cholecystectomy Clinician workgroup for value-driven care (VDC).

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Nexus Surgical @ Parkway East

Nexus Surgical @ Gleneagles Medical Centre

Nexus Surgical @ Mt. Alvernia

Nexus Surgical @ Mt. Elizabeth Orchard

Nexus Surgical @ Mt. Elizabeth Novena

Nexus Surgical @ Parkway East

Nexus Surgical @ Gleneagles Medical Centre

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