Dilation of the bile ducts: symptoms, treatment

The dilation of the bile ducts reveals a dysfunction of the flow of bile at the level of the liver and disturbs digestion. Gallstones, inflammatory diseases, sometimes cancer… Explanations with Dr. Karim Chaouchi, gastroenterologist and interventional hepatologist.

Definition: what is bile duct dilation?

The bile ducts are very small channels located inside the liver, which will unite to form the main bile duct, which generally has a caliber that does not exceed 5 to 6 millimeters. It is through the latter that circulates bile in the intestine for digestion. Biliary dilation is a enlargement of the diameter of the intrahepatic ducts or the main bile ductbetween the liver and the duodenum, when there is an obstacle inside the liver.

What are the symptoms of a dilated bile duct?

Patients have badly when it comes to an acute dilation which occurs suddenly. “The duct becomes clogged very gradually due to inflammatory narrowing such as sclerosing cholangitis (inflammatory and sclerosing damage to the intra- or extrahepatic bile ducts)“, adds Dr. Karim Chaouchi. Patients may not have pain, but present jaundice, jaundice “in the setting of tumor shrinkage with tumors in the ducts”, of the itching “Bile no longer flows in the intestines”of the dark urine “since bilirubin flows back into the liver and into the blood, and is secreted in the urine“, and then biliary pain “dilated ducts putting pressure on the liver”.

What are the causes of dilated bile ducts?

The causes of a dilation are either of obstructive mechanical origin due to the presence of stones or lithiasis”which form and come from the gallbladder, go into the hepatic duct or the main bile duct, and which will obstruct the flow of bile. The bile flow is then slowed and the bile duct dilates“, underlines Dr. Chaouchi. The dilation of the bile ducts can also be due to tumor obstacles, cancers : cancers of the bile ducts which is constituted on a part of the bile duct and which will obstruct it. “This is a cholangiocarcinome which can be located inside the liver at the level of the intrahepatic ducts which will dilate or on the main bile duct which will dilate upstream of this tumoral narrowing“, he adds. pancreatic cancers with a tumor in the head attached to the bile duct can also be one of the causes of this dilation, as well as the tumors of the papilla, enculumat the exit of the bile duct in the duodenum.

Usually the diagnosis is clinique and is confirmed by a imagery : Patients present with biliary-type pain (hepatic colic), which may manifest as an acute obstruction. You can also make a blood test for liver function tests and observe the enzymes of cholestasis: the gamma GTs, the alcamine phosphatases, the albumin and the transaminases are, in this case, elevated. Lultrasound, scanner or MRI will confirm the presence of a benign or malignant biliary obstruction.

What is the treatment for dilated bile ducts?

Treatment depends on the causal diagnosis. If it is a calculation formed in the bile duct and located in the main bile duct, a biliary endoscopy and ERCP extraction (perendoscopic retrograde cholangiography). If it is an inflammatory narrowing, we realize by endoscopy balloon dilation or gauge enlargement with the placement of stents in the bile ducts. In case of obstructive bile duct tumor, diagnosed at an early stage, excision surgery will be considered to hope for a cure. At the late stage, the treatment is palliative by placement of stents to restore bile flow.

Thanks to Dr Karim Chaouchi, gastroenterologist and interventional hepatologist, Floréal clinic, Bagnolet and Nogent-sur-Marne.

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