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Biliary blockage - symptoms, diagnosis and therapy
contents
- definition
- Gallstones as the main cause
- Cholestasis in biliary disorders
- Liver disease and biliary congestion
- Cholestasis due to blood and vascular diseases
- Risk factor: 5xF
- symptoms
- diagnosis
- therapy
- Possible diseases in a bile
definition
Our gallbladder (Vesica biliaris) is indispensable for trouble-free digestion. Because in her the bile juice (bilis) formed by the liver is stored and thickened, before it is led according to need for fat digestion into the duodenum. As a result, if we consume greasy food, we need more bile from the gallbladder's reservoir. In order to carefully break down the fat molecules of consumed food, the bile juice consists of various additives that allow it to emulsify fatty lipids. The main components are:
- water - makes up about 82 percent of the bile juice and determines its fluid consistency.
- Bile salts / bile acids - about twelve percent contained in the bile juice and responsible for the emulsification of fats in the intestine; In addition, they help the digestive enzymes to decompose the food.
- phospholipids - Phospholipids such as lecithin are present in the bile juice with a share of up to four percent and are also involved in the breakdown of dietary fats. In detail, phospholipids help to rebuild the fat droplets so that they can be metabolized by the body.
Biliary blockage is often associated with gallstone disease, but other health conditions can lead to cholestasis. (Image: PIC4U / fotolia.com) Also included in bile are low levels of cholesterol as well as the bile pigments bilirubin and biliverdin. The latter are produced in the liver by the breakdown of the red blood pigment (hemoglobin) and are temporarily stored in the bile until they are excreted from the body. The bile pigments give it its brownish color, which results from the mixing of the red bilirubin and the green biliverdin.
In a bile blockage, there is now a reduced, if not completely blocked forwarding of all the bile additives mentioned. Consequently, the bile juice can only be passed on insufficiently or not at all into the intestine, which logically severely impairs fat digestion. Depending on the respective mechanism of development, a cholestasis can be divided into two different forms:
- Extrahepatic cholestasis:
Extrahepatic means as much as "outside the liver". It can be deduced that the causes of extrahepatic cholestasis are usually not found in the liver. In most cases there are mechanical impairments of the bile flow, as is the case, for example, with a blockage of the biliary tract caused by gallstones. - Intrahepatic cholestasis:
Intrahepatic cholestasis, as a counterpart to extrahepatic biliary congestion, describes those forms of the disease which are based on causes "within the liver". It is therefore due to liver problems to the backlog of bile juice. For example, liver diseases such as hepatitis or liver poisoning due to excessive alcohol consumption are conceivable.
Often the bile blockage is due to an already existing gallstone disease. (Image: Henrie / fotolia.com) Gallstones as the main cause
As already mentioned, biliary congestion is very often due to an already existing gallstone disease (cholelithiasis). The gallstones are caused by a material imbalance in the composition of the bile. An excess of solid substances - significant bile salts - provokes here often first a bile, which means the viscous thickening of the bile juice by too many solid constituents. This is followed by the breakdown of salt crystals, which gradually condense into a gallstone.
At the beginning, the gallstones are still very small and remain in the gallbladder for the time being. In the further course, however, these so-called choleliths can dissolve and migrate into the bile ducts, where they then block the mass transfer. Gallstones are responsible for the bile blockage, it is called an extrahepatic cholestasis.
Cholestasis in biliary disorders
Some other extrahepatic causes of biliary congestion hide behind serious gallbladder disease. It is conceivable, for example, a bile duct inflammation (cholangitis), in which inflammation caused swelling in the bile ducts. The bile can not be dissipated without disruption here, which ultimately has the bile congestion result. The situation is similar with gallbladder inflammation (cholecystitis), with more blockages occurring at the portal of the bile ducts.
Both cholangitis and cholecystitis are the cause of gallstone disease in about 90 to 95 percent of all cases. However, a tumor event can trigger the blockade. Moreover, tumors like bile duct carcinoma are capable of triggering cholestasis on their own. A third cause associated with strictures of the bile ducts is also scarred bile tissue. This occurs, for example, in the context of bile duct surgery.
Liver disease and biliary congestion
Diverse are the possible causes of cholestasis even in intrahepatic forms. First and foremost, it is liver inflammation (hepatitis), which repeatedly causes bile-blockage. Specifically, at an advanced stage, hepatitis affects the formation of bile in the liver. This is more likely when viral hepatitis is due to:
- adenoviruses,
- enteroviruses,
- Epstein-Barr virus,
- Herpes viruses,
- mumps virus,
- rubella,
- Varicella-zoster virus
- or yellow fever viruses
is present. The virus infection has a massive effect on the secretion of bile, which in the episode more viscous and can contribute to the formation of gallstones in addition to a bile backlog. Furthermore, a liver tumor (Leberhämangiom) as a trigger of cholestasis is conceivable. As with the bile duct carcinoma, the transport of bile to the gallbladder is hampered by tumor-related constrictions, causing the bile backlog.
Some other disorders in the transport of bile from the liver to the gallbladder can be derived from unfavorable substance influence. Alcohol, but also drugs and toxins often contribute to an altered or disturbed secretion in the liver. At the same time, the substances can also cause irritable liver swelling and liver enlargement.
It can also cause such a bulky body processes such as pregnancy, the cause of a bile. (Image: drubig-photo / fotolia.com) In addition, space-occupying body processes such as pregnancy can not be ruled out as causes. Here it is the steadily growing unborn child who pushes on the liver if necessary and thus hinders the bile flow.
Cholestasis due to blood and vascular diseases
Speaking of pregnancy: Now and then a bile can also occur in newborns. The cause in these cases is usually due to a blood group intolerance of the child, which in the later course can lead to increased bilirubin secretion and thrombosis in the bile ducts. In fact, thrombosis in the bile and liver area is another health complaint that may contribute to the constriction or complete closure of the bile ducts.
Risk factor: 5xF
A special risk group is formed by a special type of woman, which is also referred to in the medical jargon as "5xF". The term comes from the English terms for the five properties attributed to this risk group, namely:
- female,
- fair hair,
- fertile (fertile),
- overweight (fat),
- around 40 years old (forty).
Why these patients suffer from biliary congestion relatively often has not yet been fully clarified. However, it can be assumed that the special menopausal hormone status of women around the age of 40 plays a role in bile secretion as well as in the remodeling of bile and liver tissue. On the other hand, genetic peculiarities of light hair and skin types as well as the challenge of fat digestion in case of obesity seem to play into the problem.
A gall bladder can also hide for a long time behind very nonspecific complaints, such as nausea. (Image: terovesalainen / fotolia.com) symptoms
A bile block usually manifests itself in a number of specific symptoms. However, it can also be very often that, for a while, it hides behind very unspecific symptoms for a while, but often occurs specifically after eating certain (mainly fatty) foods. These non-specific complaints include:
- nausea,
- Abdominal pressure,
- bloating,
- Flatulence (meteorism),
- Slight viscosity up to 38 ° C,
- dullness,
- diarrhea.
In most cases, these symptoms often occur after luscious meals and resolve themselves within a few hours. This is also the reason for the risk of biliary congestion: Often, these symptoms only then unmask themselves as manifest bile problems and turn into more specific symptoms when the body is in an acute situation due to the biliary congestion and one of the possible complications such as for example, has set a biliary colic, an inflammation, a threatening perforation, a gall bladder abscess or even an incipient liver failure.
The specific symptoms of a gall bladder then set in very suddenly and now often lead to a very drastic, stressful and above all anxiety-triggering situation in those affected. In the following, the complaints that are characteristic for a bile-blockage are explained in more detail:
Pain
The nonspecific and rapidly decaying upper abdominal discomfort culminate in violent, spasmodic pain in the upper and middle abdomen, which can radiate into the back and the right shoulder. Often, these pain conditions, known as biliary colic, in combination with vegetative side effects such as sweating, nausea, vomiting and impending circulatory collapse with increased heart rate (tachycardia), low blood pressure (hypotension) and increased breathing (tachypnea) on. In very serious cases, the pain situation can spread to an acute abdomen, which manifests itself in a bulging abdominal wall and a defense tension.
jaundice
Due to the backlog of bile pigments, cholestasis may cause pale stools and bilirubin and biliverdin accumulation in the body tissues. The resulting symptoms of jaundice (jaundice) is therefore very often an indication of existing disorders in bile transport.
Due to the bile block, the bile can no longer drain into the intestine and accumulates back into the liver. As a result, the blood breakdown product bilirubin produced in the liver can no longer be dispensed into the necessary amount in the bile and passes into the blood. With the normal blood flow, the bilirubin now spreads in unusually high concentration in the body and enters the tissue, resulting in a variety of easily observable symptoms:
- Yellowing of the skin in combination with severe itching,
- Yellowing of the white dermis of the eyes (sclerencystus),
- Decoloured bowel movement (pale yellow to white),
- (dark) brown discoloration of the urine.
Warning: In very serious cases, the liver may also be restricted in its function due to the bile problem. This may result in disturbances in the blood clotting (noticeable by an increased bleeding tendency) and in the protein balance (noticeable by increased edema in the area of the trunk and the extremities)!
diagnosis
Sometimes a bile-blocker is only accidentally diagnosed on abdominal ultrasound examinations that were actually performed with a different focus. It often comes to this incidental finding, if a stone suffering of bile is the cause of biliary congestion.
If a bile is suspected to be the cause of the symptoms, doctors will perform an ultrasound scan of the abdominal area to support the suspected diagnosis. (Image: Elnur / fotolia.com) If a physician suspects a bile-blocker as the cause of the symptoms of those affected, an ultrasound examination of the abdominal area is carried out to support the suspected diagnosis. Here also possible causes for the bile blockage can be assessed. For example, gallstones can usually be assessed very well sonographically and demarcated in their condition and size.
If a thickened gallbladder wall presents itself, this is a clear indication of an ongoing inflammatory process in the gallbladder. Also, a possible involvement of the liver can be determined in the context of an ultrasound examination.
Since the symptoms of a biliary congestion theoretically allow other diagnoses, these should be excluded by further diagnostics. The following examinations are available for this purpose:
| differential diagnosis | research methods |
| Heart attack | ECG, echocardiogram |
| Intestinal obstruction (ileus) | X-ray and / or CT of the abdomen |
| Pneumonia | Chest x-ray, pulmonary function test |
| Pyelonephritis, cystitis | Sonography, urinalysis |
| Pancreatitis (pancreatitis) | ERCP |
To support the diagnosis, the doctor will also carry out laboratory tests on the blood. Typically, the inflammatory values (CRP, erythrocyte sedimentation rate, small blood count), bilirubin levels (direct and indirect bilirubin) and liver values (GOT, GGT, GPT, alkaline phosphatase) are determined. If doctors suspect a tumor as the cause of the bile-blockage, they will initiate a CT scan in order to find localizations of other ulcers. Before a suitable therapy could take in this case also sampling of the internal organs to those affected.
therapy
Since the possible causes of a bile blockage are very different, physicians must decide on a case-by-case basis which therapeutic measures are effective. Surgery can not be avoided in the vast majority of cases. Be it gallstones or even organ sections of the liver or bile must be removed in order to achieve an improvement in the patient's condition. In addition, medicinal and herbal remedies or home remedies are available to alleviate the symptoms.
surgery
Cholestasis is almost always an event that eventually requires surgical intervention. In case of gallstone disease, various surgical methods are available in this regard.
One conceivable option is the endoscopic extraction of gallstones, also known as endoscopic retrograde cholangiopancreatography (ERCP for short). The procedure can already be used during the diagnosis and, after the endoscopic examination of the gallbladder and the bile ducts, allows the removal of the stones with appropriate instruments. Before removal, the bile ducts must first be inflated by a balloon and artificially expanded. The laying of a catheter through which the gallstone is later derived, is possible with the help of endoscopy.
To remove gallstones, there are various procedures. One can eliminate them among other things by means of an endoscopic extraction or smash them with an extracorporeal shockwave lithotripsy. (Image: jozsitoeroe / fotolia.com) An alternative treatment method for stone removal is the extracorporeal shockwave lithotripsy (ESWL), in which the gallstones are shattered by shock waves. However, there is a high risk that residues of smashed stones remain in the gallbladder and the stone disease flares up after a few years.
Patients who frequently suffer from gallstones or bile problems or who have a serious tumor disease will sooner or later be confronted with surgical removal of the gallbladder (cholecystectomy). This can be done in two ways:
- Cholecystectomy through a laparoscope - The gallbladder is removed by the keyhole principle through several small holes in the abdominal wall.
- Cholecystectomy by laparotomy - The gallbladder is removed via an abdominal incision.
Usually one tries to give preference to a laparoscopic removal, as this intervention is associated with a fast recovery time for the affected person and less stressful for him. However, if the doctors are facing major complications, a laparotomy may have to be performed, resulting in surgical removal of the gallbladder (cholecystectomy).
Although it is possible to treat a gall bladder conservatively and thereby also support it with natural approaches, however, a cholestasis is a disease that is very often associated with a so-called boomerang effect. Patients will most likely be confronted again and again with the symptoms of a bile, in ever shorter intervals and with increasing violence. This also increases the complication rate, which can even be life-threatening. Therefore, one has now begun to operate very quickly in bile problems. Especially in view of the fact that cholecystectomy under non-life-threatening circumstances is a very simple operation with a low complication rate and a fast recovery time for those affected.
Medical therapy
Gallstones, the cause of bile-blockage, may also be removed by means of litholysis. Specialized medicines based on ursodeoxycholic acid or chenodeoxycholic acid are administered. The active ingredients ensure a dissolution of the stones in the body, which can then be easily eliminated. However, there is a similar high rate of recurrence in litholysis as in the case of stone fragmentation. This is especially true for gallstones that are larger than five millimeters, which is why the drug process is usually used only for very small stones.
For cancers of the liver or gall bladder, as far as possible, a combination of surgery and radiotherapy or chemotherapy is used. The tumor is first irradiated for some time or treated with chemotherapeutic agents such as Fuorouracil, cisplatin or Irnotecan to make it smaller. Thereafter, surgeons perform an intervention that ideally removes the tumor tissue completely. If this is not possible, complete removal of the affected organ may be necessary to prevent the cancer cells from spreading.
If sufferers have acute symptoms, doctors will first try to control the symptoms with medication. (Image: motortion / fotolia.com) If a person with acute symptoms seeks out a doctor, they will not immediately order an operation, but first try to control the symptoms with medication. The same applies to bile or liver inflammation, which can also be treated with medication. Here you will find medicines with different starting points:
- Pain:
To relieve the pain, various painkillers are available. However, with a view to an upcoming surgery, analgesics should be avoided, which at the same time have a blood-thinning effect, such as ASA or aspirin. The drugs of choice are therefore Novalgin, Ibuprofen and Metamizol. - Cramps:
The pain is very often associated with severe spasms in the abdominal area. These can be treated very well with the spasmolytic Buscopan. This medicine can be administered both as a tablet and in suppository form or via the vein. - Inflammation:
A common complication of cholestasis is inflammation. In order to be able to control this, an antibiotic is often administered. Occasionally, antibiotic therapy, even in the absence of inflammatory signs and parameters, started purely prophylactic.
As long as there is no danger to life, those affected will be treated symptomatically until their general condition is compatible with surgery. This approach has been proven to reduce the risk of potential complications associated with surgery.
home remedies
Those affected can also become active in the event of bile dysfunction and actively support the acute phase of biliary congestion with their symptoms as well as the healing process after surgery.
- Acute phase with various bile problems:
The doctors' drug therapy regimen can be supported by nutritional support (only swallowing tranquilized or unsweetened herbal tea), bed rest, warm abdominal wrap, and close control of body temperature (indicative of the inflammatory process). - After the operation:
After successful surgery, sufferers may still be struggling with bloating, flatulence and diarrhea up to half a year later. This can be taken as an indication that the body is not yet fully used to the new condition and is responding to certain foods or luscious meals with these symptoms. A change in diet and nutrition can certainly help here. Generally, a low-fat and high-fiber diet is often recommended in the context of biliary disorders. However, sufferers can also simply test themselves, which foods they get well and on which they should simply do better in the future.
There are some natural healing products that help with bile problems, such as the student salts number 7 and 10. (Image: Gerhard Seybert / fotolia.com) Naturopathy and other measures
In the phase of acute symptoms one can support the body with some Schuessler salts and homeopathic remedies. In case of severe pain, the Schuessler salt no. 7 can be used several times a day as "hot sieves" to relieve the pain. And the Schüßler salt No. 10 is said to stimulate bile-flow. In the field of homeopathy, the following preparations can be used in connection with bile problems:
- Nux vomica (at fullness after eating, upper abdominal discomfort),
- Berberis (for colic, to purify),
- Carduus marianus (milk thistle, the "liver and gall medium" par excellence),
- Chelidonium (in pain).
Also with the nutrition one can support the bile problems by the frequent use of certain medicinal plants and herbs. The medicinal plants have two different starting points:
Lowering cholesterol as a building material that can lead to gallstones:
- A glass of water with one to two tablespoons of lemon juice or apple cider vinegar (once or twice daily).
- One to two tablespoons of psyllium husk (in cereal or smoothie or pure, once or twice daily).
With the diet, one can support bile problems, for example, psyllium husks have a cholesterol-lowering effect. (Image: farfalla2017 / fotolia.com) Strengthen the health of the liver and promote bile-juice excretion:
- Salad of dandelions,
- Peppermint tea, sheep's tea,
- Beetroot and artichoke as a side dish to a meal,
- Use of the spice turmeric.
Possible diseases in a bile
- gallstones,
- Gallen Gries,
- Cholangitis,
- cholecystitis,
- Cholangiocarcinoma,
- hepatitis,
- Leberhämangiom,
- liver poisoning,
- thrombosis.
(Ma)