Blocked bile excretion

Introduction Once a tumor or a stone occurs in the extrahepatic biliary system, the biliary tract is blocked, and the bile cannot be drained smoothly, and obstructive jaundice occurs. When the biliary system is blocked, the excretion of bile is blocked, and the jaundice caused by the return of bilirubin to the blood is called obstructive jaundice. The obstruction site may be in the liver or outside the liver, with complete obstruction and incomplete obstruction. Common causes include capillary bile duct hepatitis, cholelithiasis, liver cancer, cholangiocarcinoma, pancreatic cancer, and biliary ascariasis.

Cause

For any reason, obstructive jaundice can occur as long as the bile duct is blocked.

First, it is a benign cause, like the most common:

(1) Bile duct stones or Mirrizzi's stones block the bile duct, causing bile to be discharged into the duodenum.

(2) Patients with chronic pancreatitis form a pseudotumor of the pancreatic head and compress the bile duct from the outside.

(3) The narrowing of the bile duct due to inflammation or surgery.

(4) Others such as rare biliary bleeding, blood clots block the bile duct, causing jaundice; liver flukes or worms mistakenly entering the biliary tract.

Second, it is a malignant cause:

(1) The malignant tumor of the bile duct itself or the gallbladder (cholangiocarcinoma).

(2) Pancreatic head cancer.

(3) Walter ampullary cancer - duodenal papillary cancer.

(4) The liver cancer embolism plugs the bile duct - the so-called jaundice type liver cancer.

(5) The enlarged lymph nodes of the bile duct in cancer patients cause bile duct obstruction.

an examination

Related inspection

CT, biliary and spleen CT examination of venous cholangiography

(1) The sclera (white eyeballs) and the skin are yellow, with an early golden color, a yellow-green color in the middle, and a greenish brown or even black in the late stage.

(2) The urine looks like a tea, which is the reason for the increase in blood bilirubin.

(3) The stool is grayish white or white clay-like, because the obstruction of the bile duct can not be caused by the yellowing of the bile.

(4) Itchy skin is the result of bile salt deposition in the subcutaneous stimulation of peripheral nerves.

(5) bradycardia, caused by bile salt stimulation of the vagus nerve. In clinical diagnosis and treatment, mainly using B-ultrasound, CT, PTC (percutaneous liver puncture), MRCP (magnetic resonance cholangiopancreatography), ERCP (endoscopic retrograde cholangiopancreatography) and other invasive or non-invasive imaging, interventional Check the measures to determine the cause of the obstruction.

Endoscopic retrograde cholangiopancreatography (ERCP) is an important means for the diagnosis of biliary and pancreatic diseases by duodenoscopic retrograde intubation. The biliary tract and the pancreatic duct are commonly opened in the duodenal papilla. The duodenum is inserted into the duodenum by the mouth. The nipple is found. The contrast tube is inserted into the bile duct or the pancreatic duct through the nipple, and the contrast agent is injected to make the biliary or pancreatic duct. Developed for the purpose of diagnosing biliary and pancreatic diseases.

Differential diagnosis

Differential diagnosis of obstruction of bile excretion:

1, bile reflux gastritis, also known as spastic reflux gastritis, refers to a series of manifestations of upper abdominal pain, vomiting bile, bloating, weight loss caused by bile reflux into the stomach, common in gastric resection, After gastrointestinal anastomosis, the total incidence rate is about 5%, and the incidence after Billroth II gastrectomy is 2 to 3 times that of Billroth I. In view of the fact that its symptoms, pathological changes and treatment response are different from other post-gastric resection syndromes, Roberts et al. classify the disease from complications after gastrectomy and list it as an independent disease.

2, bile reflux: bile reflux gastritis, also known as spastic reflux gastritis, refers to a series of manifestations of upper abdominal pain, vomiting bile, bloating, weight loss caused by bile reflux into the stomach, common After gastrectomy and gastrointestinal anastomosis, the total incidence rate is about 5%, and the incidence of Billroth II gastrectomy is 2 to 3 times that of Billroth I. In view of the fact that its symptoms, pathological changes and treatment response are different from other post-gastric resection syndromes, Roberts et al. classify the disease from complications after gastrectomy and list it as an independent disease.

3, biliary stasis: imaging diagnosis, most of the gallbladder stones in the early stage can be expressed as biliary stasis and then formed bile mud, stones. The white blood cell count was significantly increased, the urinary tricholic abnormalities, elevated blood bilirubin, and abnormal liver function (such as ALT, AST, r-GT, ALP, etc.) increased to varying degrees. B-ultrasound, CT examination showed gallbladder enlargement, bile duct expansion and calculus, ERCP, PTC examination can more clearly show the lesions inside and outside the bile duct.

4, bile retention: common in the stomach: gastric juice yellow turbid, mixed with bile juice, mucous membrane smooth, no obvious congestion and edema, no ulcers, tumors. Gastric antrum: good peristalsis, mucosal plaque-like congestion and yellow bile, no obvious erosion, ulcers and masses. According to the gastroscope, the whole digestive tract is checked. Bloating, suffocating. The stomach feels full of swelling all day long. It feels bad after getting up in the morning and getting up in the morning. It is fasting on an empty stomach and after a meal. Sometimes you can get up in the morning and get up and feel comfortable after the gas is discharged.

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