home Calculators What should be the treatment if the bile ducts are clogged? Bile duct blockage

What should be the treatment if the bile ducts are clogged? Bile duct blockage

Blockage bile ducts– a sharp decrease in their patency due to any mechanical obstacle. Normally, the bile ducts ensure the removal of bile from the gallbladder into the duodenum. Blockage of these pathways is the pathological basis of subhepatic (obstructive) jaundice.

Impaired patency develops through two mechanisms. The first is the formation of an obstacle inside the gastrointestinal tract. The second is compression of the bile ducts from the outside. Obstruction of the gallbladder can be complete or partial.

Emergence

Obstruction often occurs against the background of inflammation of the biliary tract. Bile moves through the edematous gallbladder with difficulty due to a decrease in their lumen. In such a situation, patency can completely disappear if even the smallest stones get in the way.

Bile that does not move further begins to accumulate above the obstruction site, increasing the pressure in the gallbladder. This helps to dilate the bile ducts. If bile cannot penetrate the required amount into the duodenum, absorption is impaired. fat-soluble vitamins(A, D, E, K).

The progression of congestion at the level of the cystic duct leads to the accumulation of bile in the gallbladder. This becomes one of the provocateurs of organ stretching, the appearance of signs of inflammation, and the formation of dropsy (fluid accumulation).

When the outflow of bile in the blood is disrupted, the level of direct bilirubin. If congestion affects the intrahepatic bile ducts, hepatocytes begin to destroy. IN severe cases this leads to release into the blood large quantities unbound bilirubin. He provides toxic effect on body tissue.

Symptoms

The clinical course is directly related to the degree of obstruction, its duration and main reason. Symptoms of blocked bile ducts:

Pain syndrome. The most typical localization is the area of the right hypochondrium. The complaint is pronounced and may be cramping in nature.
Jaundice. The color of the skin and sclera changes. With prolonged disruption of the outflow of bile, skin itching is often a concern.
Change in color of stool and urine. The feces become discolored and the urine becomes darker. If the obstruction is transient, their change may be periodic.
Hyperthermia. Occurs against the background of inflammation of the gallbladder and gallbladder.
Asthenovegetative syndrome. Weakness, increased fatigue, drowsiness.

As congestion progresses, severe toxic damage to almost all organs and systems is possible. Therefore, measures to eliminate biliary obstruction should be taken as early as possible.

Important! Vitamin K deficiency is one of the pathological causes of decreased blood clotting. With prolonged obstruction of the gallbladder, there is a tendency to bleeding.

Diagnostics

To establish a diagnosis, the patient’s complaints, objective examination data, and results are analyzed. laboratory research. Instrumental techniques help to finally determine the cause of the obstruction of the gallbladder.

Laboratory methods

Supportive role in the diagnosis of obstruction biliary tract blood and stool tests are performed. Namely:

Clinical blood test. Against the background of inflammation, an increase in the number of leukocytes and an acceleration of ESR are observed.
Blood chemistry. Increased levels of AST, ALT, bilirubin (mainly direct), alkaline phosphatase. Upon joining reactive pancreatitis amylase levels increase.
Prothrombin time. It is increasing. This indicates a decrease in blood clotting.
Coprogram. Feces contain particles of undigested fat; it is acholic (discolored).

Additional tests are prescribed individually as needed. For example, in case of obstruction of the bile ducts by a tumor, histological and cytological examination a piece of tumor (under a microscope).

Instrumental examination

Techniques can be invasive or non-invasive. The type of study preferred depends on the suspected cause of the gastrointestinal tract obstruction. Main types:

Ultrasound of the gallbladder and ducts. Allows you to detect stones in the gallbladder and record the degree of expansion of the common bile duct.
Laparoscopy. A minimally invasive intervention, which is usually of a therapeutic and diagnostic nature. Allows you to accurately determine the area of obstruction and eliminate its cause.
MRCP. Magnetic resonance cholangiopancreatography – non-invasive method, which helps to evaluate in detail anatomical features organs of the biliary system. Allows you to determine the exact size and location of tumors.
Dynamic scintigraphy. It is based on recording areas of accumulation of radioactive isotopes introduced into the body. Allows you to assess the degree of disruption of the outflow of bile and examine the condition of the liver tissue.
RCP. Retrograde cholangiopancreatography is a combination of endoscopic examination with X-ray contrast. Under the control of an endoscope, a contrast agent is injected into the gallbladder, then X-ray. If a tumor is visualized during the procedure, a piece of tissue is taken for examination. During endoscopy, it is possible to remove the stone from the common bile duct.
HHHG. Percutaneous transhepatic cholangiography. It is also based on fixing the area of distribution of the contrast agent. The main difference from RCP is the introduction of a diagnostic drug in the direction of the physiological flow of bile. This allows you to determine the level of obstruction and its extent.

Treatment

The main specialists involved in the fight against pathology are a surgeon and a gastroenterologist. Treatment of biliary obstruction consists of surgical and conservative measures. Surgical intervention comes first in importance. Therapeutic treatment is auxiliary in nature and includes detoxification, anti-inflammatory, antibacterial therapy.

A patient with urinary tract obstruction is not always initially in a stable condition. In such situations, take gentle measures:

Gallbladder puncture;
Cholecystostomy;
Choledochostomy;
Percutaneous transhepatic drainage (ensuring the outflow of bile through the drainage system that has accumulated above the blockage);
Removal of stones during RCP;
Nasobiliary drainage for GCHD (installation of a catheter in the bile ducts).

After stabilization of the patient's condition, treatment of the bile ducts is carried out more radically. If possible, all manipulations are performed through laparoscopic access. If for some reason it is impossible (for example, due to complications), they resort to laparotomy. Some types of interventions:

Bougienage of the bile ducts. When they are obstructed due to strictures and scars.
Biliary tract stenting. Installation of a special tube at the site of stenosis.
Cholecystectomy. Removal of the gallbladder.
Expansion of the sphincter of Oddi. Used when its patency is impaired.

Conclusion

Obstruction of the bile ducts is a condition that requires mandatory medical intervention. Severe obstruction of the gallbladder without appropriate treatment is fraught with sepsis, damage to the central nervous system (due to bilirubin intoxication), and liver failure. The best way To avoid this, consult a doctor in time at the first signs of pathology.

A blocked bile duct is considered an obstruction and blockage of the channels leading from the liver to the gallbladder, and then to the intestines. This is a kind of mechanical obstruction that occurs due to a stone or as a result of external compression of the ducts. Pathology is characterized by its causes, symptoms and consequences, which you should know about in order to correctly identify the disease and complete the full course of treatment.

Causes of blockage

Let's take a closer look at the description of bile duct blockage.

Bile is produced in the liver, then stored in the gallbladder, and then used in the intestines. After eating, a small portion of bile enters directly into the intestines from duodenum, where it digests fats, especially animal origin, and vitamins. The rest of the bile usually remains in the gallbladder.

In medicine, partial or complete obstruction of the biliary tract is distinguished. The following factors may be to blame for blockage of the common bile duct:

Obstruction of the tract can be caused by diseases such as cholangitis and cholecystitis, along with chronic pancreatitis, pancreatic tumors, infections of the liver and intestines, recent operations on these organs and injuries to the right half of the abdominal cavity. Fluctuations in body weight along with obesity or losing weight too quickly may be the cause of the blockage.

What are the signs of blockage of the bile ducts, we will consider below.

Pathogenesis of blockage

Bile, when passing through blocked ducts, cannot move with normal speed. Because of this, it accumulates in the place where there is an obstacle, stretching the walls of the elastic tube. Very often, inflammation soon develops in this area, causing the mucous membrane to become very thick, which in turn also causes a decrease in the diameter of the ducts.

Bile is then absorbed and released serous fluid. This liquid is called white bile. This phenomenon indicates significant damage to the liver tissue, due to which there is a failure of the functions of this organ along with a disorder of carbohydrate and fat metabolism And pathological changes in internal organs, for example, in the kidneys and heart.

The causes and symptoms of bile duct blockage are interrelated.

Directly in the liver itself, if a blockage has occurred in it, the accumulated bile affects its cells in a toxic manner, against the background of which bile acids and bilirubin cause their destruction. Prolonged bile stagnation causes severe pathologies of this organ, including the development of liver failure. In addition, bile substances are able to penetrate into the blood, causing its intoxication along with damage blood vessels and body organs.

Symptoms

Symptoms of bile duct blockage include various components. For example, the following manifestations may occur:

The occurrence of skin itching and rashes.
Staining of the skin and sclera yellow.
The appearance of bitterness in the mouth, and in addition, a coating on the tongue.
Bad breath.
The occurrence of pain in the right hypochondrium.
The appearance of a headache.
Enlargement of the abdomen and slowing of the pulse.
Slowing down blood clotting processes.
Light-colored and extremely unpleasant-smelling stool.
Dark urine, stained with bilirubin.

What happens in advanced stages?

IN advanced cases Diseases: Patients may experience swelling along with sweating, and in addition, intellectual impairment. Since these symptoms can also manifest themselves in other diseases digestive system, then the diagnosis is established only after special diagnostic procedures.

Diagnosis of the disease

To diagnose blockage, a biochemical blood test is taken from patients and, based on the results, cholangitis with cholecystitis is excluded, the total amount of bilirubin, liver enzymes, and alkaline phosphatase is determined. Among the hardware research methods are prescribed ultrasonography, which makes it possible to determine whether there are stones and pneumobilia in the bile ducts, that is, the presence of air in them, which can occur as a complication of hepatic and biliary pathologies.

Endoscopic or laparoscopic examination

Using these techniques, the presence of cysts or stones in the bile ducts is established. Such studies are prescribed if the symptoms of the disease are not very pronounced and there is an assumption that the pathology is still in its infancy. mild form. Diagnostic tools also involve taking a piece of tissue if cancer is suspected.

Magnetic resonance and computed tomography allow you to see detailed images of the liver and pancreas ducts. If the diagnosis of “blockage of the bile ducts” is confirmed, then therapy is prescribed based on the results of the study.

Treatment of pathology

Treatment of blocked bile ducts aims to completely or at least partially free them from the blockage. One of the existing options for removing stones from the ducts is the use of an endoscope as part of an endoscopic cholangiopancreatography or papillosphincterotomy. Such operations are prescribed to patients if the narrowing of the bile ducts is insignificant or they are clogged with small stones.

In addition, the patency of the canals is restored using a stent, which is a hollow tube installed in clogged ducts. It helps to expand the duct when its narrowing is caused by tumor formation. After some time, a repeat operation may be required to replace the stent.

If the blockage of the bile duct was caused by stones in the gall bladder, then it is removed, this operation is called cholecystectomy. Ductal sphincterotomy is used when stones are present in the bile duct and in the duct at the same time.

In addition, traditional medicine is also used for treatment. In order to stabilize the flow of bile, patients are advised to take:

One glass at a time apple juice with a spoon of vinegar.
A glass of water with four spoons lemon juice.
A decoction of ordinary mint.
Juice made from one cucumber and beetroot, as well as four carrots.

Any of these medicines should be consumed daily for at least two weeks to get results. But it's worth keeping in mind that traditional treatment blockage of the bile duct cannot be a replacement for the traditional one, but only complements it.

Carrying out prevention

To prevent blockage, the occurrence of diseases of the biliary tract and liver should be prevented. First of all, it is required for these purposes to do the following:

Use only healthy ingredients, and at the same time good nutrition.
Maintain a healthy lifestyle in general. This measure will prevent many different diseases that cause barriers to the bile duct. Such barriers are often tumors along with scars, adhesions, narrowing, and the like.

In order to protect yourself from the appearance of diseases of the digestive system, which can in turn provoke blockage of the bile ducts, the diet must be followed not from time to time, but throughout life. There are the most important canons:

It is required to eat food in a timely manner, be it breakfast, dinner or lunch. It is very important to observe the proportions of the products you take. You should avoid eating excessive amounts of food in the evenings.
It is imperative to include hot foods, such as soups, in your daily diet.
Important complete failure from unhealthy food in the form of hot dogs, fried street pies, French fries, branded sodas.
It is extremely necessary to exclude from your diet foods that are harmful to the bile ducts. This primarily includes fatty foods in the form of meat, sour cream, borscht and fried foods. You can't get carried away and spicy food with lots of black and red hot pepper and other seasonings. You should also avoid extractive foods that increase the secretion of digestive enzymes and bile; thus, you should not eat saturated broths.

In the event that liver pathologies do arise, they should be diagnosed and treated in a timely manner, since sooner or later they can lead to blockage of the bile ducts.

Disease prognosis

The prognosis for symptoms of bile duct blockage is usually favorable, provided that the patient is diagnosed in a timely manner correct diagnosis and provided necessary help. The forecast may be difficult in a number of the following cases:

Against the background of cancerous lesions of the common bile duct. Such a diagnosis worsens the course of the disease and complicates treatment.
Attachment of infection and occurrence purulent processes in the bile ducts and gallbladder.
Against the backdrop of hasty surgical treatment for in serious condition patient if infusion treatment was not carried out.
In case of self-medication at home using traditional methods.

Possible complications

Often, complications of blockage of the bile duct with a stone arise if the patient is not treated in a timely manner. surgical therapy. Predominantly blockage often leads to the following complications:

The occurrence of sepsis, against the background of which the infection spreads throughout the body.
The appearance of bilirubin encephalopathy. In this case, in patients with bilirubin, brain tissue is affected, since the amount of this element in the body is significantly increased.
The appearance of liver cirrhosis.
Development acute failure liver. This occurs against the background of complete blockage of the ducts.
Appearance chronic failure liver. This occurs against the background of partial blockage of the ducts.

Final information

Thus, blockage of the bile ducts is a deterioration or complete cessation of their patency against the background of an obstacle to the flow of bile from the liver to gallbladder. This disease is considered extremely unpleasant, and in difficult cases it also poses a danger in the form of various complications, against the background of which all kinds of diseases of the digestive system can appear. Considering the seriousness of this pathology, its occurrence should in no case be ignored and if the slightest symptom occurs, you should definitely contact your doctor.

We looked at the symptoms and treatment of blocked bile ducts.

Bile ducts are a system of channels designed to drain bile into the duodenum from the gallbladder and liver. Innervation of the bile ducts is carried out using branches nerve plexus located in the liver area. Blood comes from the hepatic artery, the blood outflows into portal vein. Lymph flows to lymph nodes that are located in the area of the portal vein.

The movement of bile in the biliary tract occurs due to the secretory pressure exerted by the liver, as well as due to the motor function of the sphincters, the gallbladder and due to the tone of the walls of the bile ducts themselves.

The structure of the bile ducts

Depending on their location, the ducts are divided into extrahepatic (this includes the left and right hepatic ducts, the common hepatic duct, the common bile duct and the cystic duct) and intrahepatic. The hepatic bile duct is formed due to the fusion of two lateral (left and right) hepatic ducts, which drain bile from each hepatic lobe.

The cystic duct, in turn, originates from the gallbladder, then, merging with the common hepatic duct, forms the common bile duct. The latter consists of 4 parts: supraduodenal, retropancreatic, retroduodenal, intramural. Opening on the papilla of Vater of the duodenum, the intramural part of the common bile duct forms an orifice where the pancreatic and bile ducts unite into the so-called hepatopancreatic ampulla.

Bile duct diseases

Biliary tracts are susceptible various diseases, the most common ones are described below:

Methods for studying the bile ducts

Diagnosis of biliary tract diseases is carried out using modern methods, descriptions of which are presented below:

intraoperative chaledo- or cholangioscopy. Methods appropriate for determining choledochotomy;
Ultrasound diagnostics with a high degree of accuracy reveals the presence of stones in the bile ducts. The method also helps to diagnose the condition of the walls of the bile ducts, their size, the presence of stones, etc.;
duodenal intubation is a method that is used not only for diagnostic purposes, but also for therapeutic purposes. It consists of introducing irritants (usually parenterally) that stimulate contractions of the gallbladder and relax the sphincter of the bile duct. Advancement of the probe along the digestive tract causes the release of secretions and bile. Assessment of their quality, along with bacteriological analysis, gives an idea of the presence or absence of a particular disease. So, this method allows you to study the motor function of the biliary tract, as well as identify blockage of the biliary tract with a stone.

Blockage of the bile duct is a mechanical obstruction that occurs in the path of the flow of bile entering the duodenum to organize a stable process of digestion and breakdown fatty acids. In most cases, it develops against the background inflammatory diseases gallbladder or as a result of the formation of stones of various structures, sizes and nature of origin. The symptoms of this disease are almost always acute, and the patient admitted to the hospital complains of severe pain in the right hypochondrium. Treatment of bile obstruction is surgical in nature and is aimed at restoring the lumen of the bile duct, removing foreign objects blocking normal functioning of this organ of the digestive tract.

It will not be difficult for an experienced gastroenterologist to suspect, just by external signs, that the patient’s channels through which bile should circulate are clogged.

Symptoms of the disease first develop gradually, and then acquire vivid and specific manifestations, which is expressed in the following pathological sensations on the part of the patient:

In addition to this, the patient complains of loss of appetite, nausea, general physical weakness, periodic vomiting, stool upset.

If the duct is only partially blocked, then the symptoms of the disease disappear from time to time, but after 1-2 days they return again.

This suggests that the body is independently trying to unblock the path for a stable outflow of bile, but despite all attempts, it still persists. Negative influence a factor that does not allow digestive secretions to circulate freely and enter the organs gastrointestinal tract.

Causes of bile duct obstruction

Obstruction of the bile ducts can occur due to static compression of their walls from the outside, on the sides, or from inside the duct itself. The presence of these circumstances has a direct impact on the clinical picture of the disease. In addition, there are a number of pathologies of this part of the human digestive system that disrupt the functioning of both the gallbladder itself and its ducts. Based on this, they distinguish following reasons canal obturation:

IN medical practice There are clinical cases when inpatient department Patients were admitted to the hospital with symptoms of biliary obstruction after suffering an abdominal injury. This swipe to the right side of the abdomen, or falling from high altitude, which provoked swelling of the mucous membranes and epithelial tissues located in the circle.

Which doctor should I go to and what tests should I undergo?

It all depends on where exactly the person who is experiencing signs of bile duct blockage lives. It is recommended to make an appointment with a gastroenterologist or hepatologist. If, for one reason or another, there are no specialists of the specified profile in the clinic, how staff unit, then in this case you need to visit a general practitioner. This Family doctor, who has a large amount of knowledge and is able to carry out initial examination patient, palpate the abdominal cavity and establish that the localization of the pathology is concentrated precisely with right side in the hypochondrium area.

After this, the patient is prescribed an additional list of tests and undergoing diagnostic measures, consisting in next steps:

blood from finger for her clinical trial;
morning urine on an empty stomach;
Ultrasound diagnostics of the abdominal cavity with a particularly careful study of the structure of the liver tissue, the gallbladder, its ducts and communication routes with neighboring organs gastrointestinal tract;
venous blood for carrying it biochemical analysis;
feces to examine feces for the presence or absence of bilirubin, bile particles and other enzymes, the synthesis of which is closely related to the functional activity of the gallbladder.

In particularly complicated cases, MRI diagnostics may be required if all of the above methods have not brought the desired result and the attending physician still doubts the diagnosis.

For oncological pathologies, a biopsy is used histological analysis selected tissue samples in order to establish the malignant or benign etiology of the tumor body.

Treatment of clogged bile ducts

Treatment of the disease largely depends on clinical picture its manifestations and those symptoms that are present in a particular patient. The most commonly used are the following healing techniques.

Surgical stone removal

It can be carried out using endoscopic equipment with the aim of minimal trauma to the patient’s body, or through extensive surgical intervention with making a strip incision and opening the common bile duct (choledochotomy). At this time, the patient is in the operating room under general anesthesia.

Bougienage

The therapeutic method is intended to expand the lumen of the bile ducts if they have narrowed after suffering a severe inflammatory process, associated with the formation of multiple scars on the inside of the canal walls. A special medical equipment and endoscopic instruments.

Common bile duct stenting

This is a minimally invasive operation, the principle of which is that a special expansion stent is inserted into the cavity of the common bile duct. Its functional purpose is to relieve painful symptoms, restore bile patency and prevent relapse of the disease in the future.

Transrenal drainage

Used only in particularly difficult clinical cases when blockage of the bile ducts has caused complications and liver disorder has occurred, and the patient himself is in danger of liver failure. To avoid this kind of negative consequences, forced bile drainage is installed.

In combination with surgical treatment are actively used medications anti-inflammatory and antibacterial spectrum of action. Especially if the narrowing of the lumen of the bile duct occurs due to the entry of pathogenic microflora into it.

Prevention

In order to never encounter blockage of the common bile duct, or to minimize the risk of the disease, you should perform daily simple rules prevention, consisting of the following actions:

eating only biologically healthy products nutrition;
complete cessation of alcoholic beverages, smoking and drug use;
conducting active image life, sports;
balanced and moderate consumption of foods containing fiber, fats of plant and animal origin, meat and dishes prepared on their basis;
fried, smoked, marinated, heavily fatty food should be excluded from the menu completely;
periodically take (1 course every 6 months) medications for natural basis, which stimulate the outflow of bile and prevent it from stagnating in the bladder and ducts with further transformation into stones.

It is very important to promptly treat infectious and viral diseases liver, do not transfer them to chronic condition, which can at any time go into the stage of exacerbation and negatively affect the functioning of the gallbladder. People who pay attention to these preventive measures never have problems with this part of the digestive system and always have an excellent appetite, but do not gain weight.

Inna Lavrenko

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Obstruction of the bile ducts is usually associated with their blockage by some mechanical obstruction, which does not allow bile from the liver and gallbladder to enter the duodenum.

The cause of such blockage may be cholelithiasis, inflammation of the bile ducts, their narrowing (stricture), as well as the formation of tumors and scars in the lumen of the common bile duct (common bile duct). As a rule, it is the listed pathologies that cause bile duct obstruction. Treatment similar diseases mainly produced surgical methods– from endoscopic intervention to extended abdominal or laparoscopic surgery. Blockage of the bile duct, description, symptoms and treatment is the topic of today’s article,

This very dangerous complication occurs after a number of different diseases of the digestive system, the most common of which is cholelithiasis, which is diagnosed in almost every fifth person. Women are much more susceptible to this disease than men.

With the development of this pathology, gallstones are formed in the cavity of the bladder, which, during their migration, can partially or completely block the lumens of the bile ducts, leading to their obstruction. Disruption of normal bile outflow is accompanied by the appearance of signs of obstructive jaundice, which is characterized by yellowing skin and eye sclera, as well as strong pain syndrome. If the patient is not provided with timely qualified assistance– obstruction of the bile ducts can even lead to death.

It is worth noting that blockage of the bile ducts can be caused not only by a mechanical obstruction inside the bile duct (for example, a stone), but also by compression of the duct from the outside.

The severity of the clinical picture of the disease depends on how much the lumen of the duct is blocked.

As a rule, the process of obstruction of the bile duct begins with its inflammation, as a result of which the mucous membrane of the bile ducts thickens and the lumen, accordingly, narrows. When a gallstone gets into such an inflamed canal, it gets stuck, as a result of which the common bile duct is partially or completely blocked. Bile, having no outlet, accumulates in the ducts and stretches their walls. Since hepatic bile first enters the gallbladder, if there is obstruction of the cystic or common duct the walls of this organ also stretch, thereby exacerbating the course of cholecystitis. If this happens in the background cholelithiasis, then stones from the bladder cavity can begin to migrate into the cystic duct, causing its obstruction. Most dangerous complications such pathological process are hydrocele or empyema of the gallbladder.

If bile is retained in the intrahepatic bile ducts, this can cause destruction of liver cells (hepatocytes), as a result of which bilirubin and bile acids can enter the blood, causing general intoxication of the entire body. In addition, since bile is responsible for the breakdown and subsequent absorption of heavy lipids, its lack in the intestines leads to impaired absorption of vitamins contained in fats (A, E, K and D). This leads to the development of hypoprothrombinemia, disruption of normal blood clotting and other manifestations of hypovitaminosis. If the stagnation of hepatic bile in its excretory tract continues for a long time, this leads to serious damage to the liver parenchyma, against the background of which liver failure develops.

Risk factors that increase the likelihood of bile duct obstruction, experts include:

improper diet and regimen;
obesity;
rapid loss of body weight;
injuries in the area of the right side of the abdominal cavity;
the patient has recently undergone surgery on the organs of the biliary and digestive system;
infectious lesions of the biliary organs;
weakened immunity.

Clinical picture of bile duct blockage

As a rule, pathology begins to manifest itself gradually.

Acute manifestations on early stage– a rather rare phenomenon. As we said above, usually the onset of this process is associated with the development of inflammation or infection of the bile ducts. The patient begins to complain about elevated temperature body, weight loss and paroxysmal pain on the right under the ribs. Yellowness of the skin and eye sclera may appear, accompanied by skin itching. A deficiency of bile acids in the intestines causes discoloration of stool, and an increase in the level of direct bilirubin causes darkening of urine. If the blockage of the bile ducts is partial, alternating between discolored and normally colored stool is observed.

The destruction of hepatocytes leads to disruption of all liver functions and the development of liver failure in acute form. The very first thing that is disrupted is the detoxification function of this organ, which is expressed by the following symptoms:

general weakness;
increased fatigue;
gradual disruption of the functions of other internal organs and systems of the body (brain, kidneys, heart, lungs).

The onset of this stage of pathology development is characterized by a very unfavorable prognosis.

The clinical picture of this pathology at an early stage of its development resembles the symptoms of cholecystitis or hepatic colic.

These external signs may lead to hospitalization of the patient.

Initial diagnosis is carried out using an abdominal ultrasound procedure. When found gallstones To search for them in the bile ducts, magnetic resonance cholangiography or computed tomography may be prescribed.

In order to clarify the causes that cause obstructive jaundice, as well as to determine the location of the stone and the degree of blockage of the lumen of the duct, the technique of percutaneous transhepatic cholangiography and the method of dynamic scintigraphy of the biliary system are used. These instrumental diagnostic methods make it possible to identify disturbances in the dynamics of bile and bile outflow.

The most informative method for diagnosing biliary tract obstruction is considered to be the method of retrograde cholangiopancreatography, which involves simultaneous endoscopic and x-ray examination bile ducts. If stones are detected in the lumen of the bile duct, during such a procedure it is possible to extradite the stone from the common bile duct, and if a tumor is detected compressing the duct, it is possible to take a biopsy from it.

If speak about laboratory methods diagnostics, they allow us to identify the following:

detected in biochemical liver tests increased level direct bilirubin, transaminases, alkaline phosphatase, blood lipase and amylase;
a general blood test determines leukocytosis, in which the leukoformula shifts to the left;
this analysis also makes it possible to detect a decrease in the level of platelets and red blood cells characteristic of this pathology;
The coprogram in this disease is characterized by a significant content of fat in the feces and the absence of bile acids.

Firstly, patients with this diagnosis need consultation with a gastroenterologist and surgeon. After all the necessary examinations have been carried out, the location and degree of blockage have been determined, a surgical therapy technique is selected. Conservative methods such pathologies cannot be treated.

If the patient is in serious condition, he is transferred to the intensive care unit, where urgent infusion, antibacterial and detoxification treatment is carried out. Before the patient's condition becomes stable, surgical intervention is very dangerous, and therefore preliminary methods of facilitating bile outflow are used, namely:

If the use of these techniques does not improve the patient’s condition, more complex operation through percutaneous transhepatic drainage of the biliary tract.

After normalization general condition patient, in the absence of contraindications, the use of endoscopic methods is recommended surgical treatment. During this intervention, bougienage (expansion of the lumen) of the bile ducts is performed (in cases of cicatricial stenosis and structures caused by tumors). It is possible to introduce special plastic or mesh tubular prostheses into the lumen of the canal to increase patency (endoscopic common bile duct stenting procedure). If the calculus has blocked the scar-narrowed papilla of the duodenum, then the procedure of endoscopic balloon dilatation of the sphincter of Oddi is used.

If endoscopic methods do not allow removing obstacles to normal bile outflow, advanced types of surgical intervention are used.

Choledochotomy involves opening the common bile duct, and therefore it is necessary to take measures to prevent subsequent leakage of bile into abdominal cavity through postoperative sutures. For this purpose, external drainage of the biliary tract is carried out according to Keru using a T-shaped tube.

After cholecystectomy (surgery to remove the gallbladder), external drainage is performed according to Halstead using a polyvinyl chloride catheter, which is inserted into the area of the cystic duct stump.

If bile duct obstruction is not promptly treated with surgical techniques– this can lead to the development of sepsis, liver cirrhosis, bilirubin encephalopathy and liver failure (if the obstruction of the duct is complete, in acute form, if partial, in chronic form).

If health care If a patient with this diagnosis is provided on time, the overall prognosis is favorable. Seriously complicates the treatment of such pathologies cancer diseases common bile duct.

If we talk about preventive measures for such diseases, they include: timely treatment existing diseases of the biliary system and digestive organs, as well as in compliance correct mode and diet and healthy life.