Definition & Overview
The biliary tract, which is composed of the organs and ducts that produce and distribute bile to the duodenum (small intestines), is a vital part of the digestive system. Also referred to as the biliary tree or biliary system, the tract is made up mainly of the liver, pancreas, duodenum, and the common and perihilar bile ducts.
Bile secreted by the liver is essential in the digestion of fats. It is first stored in the gallbladder and when the digestive system detects fats, bile is released into the duodenum.
Unfortunately, like any part of the body, the biliary tract is prone to all sorts of problems. One of the most common is obstruction caused by gallstones. In such case, bile will not be released into the duodenum, resulting in liver problems that eventually cause liver failure.
However, blocked bile ducts can also be caused by other factors such as infections, scarring, or even cancer.
Another problem with the biliary tract that is not so common but usually occurs in children is a disease called biliary atresia. The condition may be rare but it is the primary cause of most liver transplant cases involving children in the United States.
Causes of the Condition
Gallstones are the primary cause of the majority of biliary tract problems. The medical community isn’t clear on why gallstones form, but it is believed that due to an imbalance in the components that make up bile, there may be an excessive amount of cholesterol or bilirubin, or the gallbladder simply doesn’t empty correctly.
The liver secretes cholesterol but the chemicals in the bile should be enough to dissolve it. However, if the liver secretes more cholesterol than bile can dissolve, the excess cholesterol forms into crystals that eventually form into cholesterol gallstones.
The liver also secretes a chemical called bilirubin. However, due to certain conditions such as liver cirrhosis, blood disorders, and biliary tract infections, the liver may secrete an excessive amount of bilirubin. The excess amount also turns into crystals and forms pigment gallstones that have a darkish brown or black color.
Biliary tract problems may or may not display any symptoms. Gallstones, for example, are typically asymptomatic and usually only discovered during a periodic medical exam or when the patient undergoes an x-ray or ultrasound for some other conditions.
However, if gallstones result in symptoms, it is usually pain in the upper abdomen that can radiate to other parts of the body, such as the chest and shoulder. If it radiates to the chest, it can feel like having a heart attack. Other symptoms are nausea, vomiting, fever, a yellowish complexion, and/or yellowish color of the eyes.
Who to See & Types of Available Treatment
If you experience any of the above symptoms, it’s best to see your doctor immediately. In fact, it’s likely that you’ll need to go to a hospital’s emergency department because if the pain from a biliary tract problem radiates to the chest, it can feel like a heart attack.
In an emergency situation, the doctor will perform a physical examination of the abdominal region and ask a few questions concerning your medical history. If the doctor determines that pain is a result of a biliary tract problem and not a heart attack, you will be referred to a specialist, such as a gastroenterologist. A series of test will be conducted to determine the causes of the symptoms. If the doctor suspects the presence of gallstones, the tests will include magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography (ERCP), or a hepatobiliary iminodiacetic acid (HIDA) scan. Blood tests will also be performed to determine if there are any complications, infections, jaundice, or pancreatitis.
In cases where the condition is not an emergency, the patient should see his primary doctor who will then refer him to the right specialist based on the results of the initial batch of tests. During the consultation, the patient’s symptoms, his current medications, and other pertinent information about his health will be discussed.
Once the exact biliary problem has been identified, the specialist will present a treatment plan. Depending on the condition and its severity, treatment may involve medication or surgery. For example, gallstones can be dissolved using medications. However, if the medications fail, they will be removed, possibly with the gallbladder, with a minimally invasive surgical procedure. Although the body can function without the gallbladder, the patient may experience episodes of diarrhea. This and other risks and complications will be discussed with the patient prior to the surgical procedure.
If the biliary tract problem is caused by a disease, such as cancer, other specialists such as an oncologist will be brought in to manage the condition. The treatment of cancer can include radiation therapy, chemotherapy, other medications, or even surgery.
Fogel EL, Sherman S. Diseases of the gall bladder and bile ducts. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 158.
Stockland AH, Baron TH. Endoscopic and radiologic treatment of biliary disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 70.