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Inflammation of the Bile Duct

Dr Thng Yongxian

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

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What is a Bile Duct?

The bile duct is a tube-like structure that carries bile from the liver and gallbladder to the small intestine. It is an important part of the biliary system responsible for transporting bile, a fluid produced by the liver that aids in the digestion of fats and proteins.

The bile duct system includes several key components, including the right and left hepatic ducts, the common hepatic duct, and the common bile duct. This system allows bile to be stored in the gallbladder or released into the small intestine as needed for digestion.

Inflammation Of The Bile Duct

The inflammation of the bile duct, medically known as cholangitis, can interfere with the normal flow of bile from the liver to the small intestine, leading to the accumulation of bile in the liver. Cholangitis can range from mild to severe, potentially leading to life-threatening complications if not treated promptly.

The inflammation may be caused by an infection, blockage, or autoimmune response, each leading to different clinical presentations and requiring different management approaches.

Causes

The main causes of bile duct inflammation include:

  • Bacterial Infections: Bacterial infections are the most common cause of acute cholangitis. Bacteria can ascend from the intestine to the bile ducts, leading to infection and inflammation.
  • Obstruction: Obstruction of the bile duct can lead to inflammation. It can result from gallstones, tumours, or strictures (narrowing of the duct).
  • Autoimmune Disorders: Certain autoimmune disorders cause the immune system to attack the bile ducts, leading to chronic inflammation and scarring.

Symptoms

Common symptoms include:

Jaundice

Characterised by yellowing of the skin and eyes, jaundice is a symptom of bile duct inflammation. It occurs due to the accumulation of bilirubin in the blood, which is a byproduct of red blood cell breakdown.

Pain

Pain in the upper right quadrant of the abdomen is common and may be sharp or dull. It can sometimes radiate to the back or shoulder.

Fever and Chills

Infections associated with bile duct inflammation often cause fever and chills, indicating the body’s response to the infection.

Dark Urine and Pale Stools

Dark urine and pale stools may occur due to alterations in bile flow, with bilirubin being excreted through the urine rather than being processed in the intestines.

Itching

Accumulation of bile salts in the skin can lead to persistent itching.

Nausea and Vomiting

Digestive disturbances may cause nausea and vomiting.

Diagnosis

Key diagnostic steps for inflammation of the bile duct include:

Clinical History and Physical Examination

A thorough medical history and physical examination are conducted. The presence of risk factors, such as a history of gallstones, autoimmune diseases, or medical procedures, can provide further diagnostic steps.

Blood Tests

Blood tests are important for assessing liver function and detecting signs of inflammation or infection.

Imaging Studies

The following methods are commonly used:

  • Ultrasound: A non-invasive method to detect gallstones, dilated bile ducts, and masses.
  • Magnetic Resonance Cholangiopancreatography (MRCP): A type of MRI that provides detailed images of the bile ducts, pancreas, and gallbladder, often used to identify strictures or blockages.
  • Endoscopic Retrograde Cholangiopancreatography (ERCP): ERCP can visualise the bile and pancreatic ducts and allow for interventions such as removing blockages or taking tissue samples.

Biopsy

In cases where autoimmune disorders or malignancies are suspected, a biopsy of the bile duct tissue may be performed to obtain a definitive diagnosis.

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Treatment Options

The treatment of bile duct inflammation focuses on addressing the underlying cause, relieving symptoms, and preventing complications. Treatment strategies may include:

Antibiotics

If an infection causes inflammation, antibiotics are the primary treatment to eliminate the bacterial infection.

Endoscopic Procedures

For bile duct obstruction caused by gallstones or strictures, endoscopic procedures such as ERCP can be used to remove blockages or dilate narrowed ducts.

Medications for Autoimmune Conditions

For inflammation caused by autoimmune diseases, medications that suppress the immune system may be used to reduce inflammation and slow disease progression.

Surgery

In cases where endoscopic procedures are not successful or feasible, or if there is a need to remove a section of the bile duct due to strictures or cancer, surgery may be necessary.

  • Cholecystectomy: This is the surgical removal of the gallbladder and is commonly performed when gallstones in the gallbladder cause recurrent episodes of bile duct inflammation.
  • Biliary Stenting: In cases where the bile duct is narrowed or blocked, a procedure to insert a stent into the duct may be performed. The stent holds the duct open, allowing bile to flow properly.
  • Bile Duct Repair or Resection: In cases where a section of the bile duct is damaged by inflammation, strictures, or cancer, surgical removal of that section may be necessary. The remaining parts of the bile duct are then reconnected to restore bile flow.
  • Liver Transplantation: For patients with severe liver damage or failure, such as from chronic bile duct conditions like primary sclerosing cholangitis, a liver transplant may be the only viable treatment option.

Managing Complications

Effective management of complications arising from bile duct inflammation is crucial for preventing long-term damage and maintaining quality of life. Strategies for managing complications include:

  • Regular Monitoring: Regular follow-ups with a doctor are essential for monitoring liver function and the status of the bile ducts. Blood tests, imaging studies, and, if necessary, endoscopic examinations help detect changes early and adjust treatment plans accordingly.
  • Managing Infections: Prompt treatment of infections, often with antibiotics, is vital to prevent the spread of infection and the development of sepsis, a potentially life-threatening condition.
  • Preventing and Treating Strictures: Regular monitoring and, if needed, interventions like stenting can help manage strictures in the bile ducts, preventing blockages that could lead to complications.

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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