Bile Duct Diseases

Diagnosis

Your doctor may suspect that you have a bile duct problem if you have any of the classic symptoms or if a blood test shows that you have a high level of bilirubin. Your doctor will take your medical history and examine you to look for clues that could explain damage to the bile ducts and liver. Because liver inflammation (hepatitis) and liver scarring (cirrhosis) can cause similar symptoms, your doctor will ask about your alcohol use, drug use and sexual practices, all of which can result in liver disease. If you have gallstones, have had pancreatitis or abdominal surgery, or have symptoms of an autoimmune condition (such as arthritis pain, dry mouth or eyes, skin rashes or bloody diarrhea), tell your doctor. Because some medicines can slow drainage through the bile ducts, your medicines should be reviewed.

You may need blood tests to measure your levels of alkaline phosphatase, bilirubin or gamma-glutamyltransferase. These are markers of bile duct obstruction. Other blood tests may suggest liver inflammation or cirrhosis. Occasionally, specialized blood tests may be helpful, such as antibody tests to diagnose primary biliary cirrhosis or primary sclerosing cholangitis, and a blood test that measures CA 19-9, which could indicate that you have cholangiocarcinoma.

If your doctor suspects a bile duct problem, additional tests will depend on the suspected cause of the disease. Commonly used tests include:

• Ultrasound of the liver, which can show enlargement of the ducts above a blockage

• Computed tomography (CT) scan or magnetic resonance imaging (MRI) scan of the liver

• Endoscopic retrograde cholangiopancreatography, an examination in which a small camera on a flexible cord is inserted through your mouth and down past your stomach to the opening where the common bile duct empties into your stomach. A dye can be injected into the common bile duct that will appear on X-rays. How the bile ducts look on the X-rays can provide clues to the problem. Sample cells from the bile duct walls can be examined under a microscope for evidence of cancer. Treatments to relieve blockages can be performed during this examination.

• Magnetic resonance cholangiopancreatography, an examination similar to the endoscopic exam above, but MRI images can be obtained without passing an endoscope into the stomach. The best information is obtained from this test when radiologists have good experience reading the results. The disadvantage of this test is that tissue for a biopsy (laboratory examination) cannot be obtained.

• Cholangiography (X-rays of the bile ducts), which can also be done after dye is injected into the liver. This enables doctors to watch the flow of bile as it drains from the liver. Tissue for biopsy can be obtained during this procedure and any blockages or narrowing can be relieved.

• A liver biopsy sample, obtained using a needle through the skin. The tissue is examined for evidence of inflammation or cancer.