Answers
What causes a blocked bile duct (obstructive jaundice)?
Short answer
When the bile duct is blocked, bile cannot drain into the gut, causing jaundice with itching, dark urine and pale stools. Common causes are stones, narrowings after surgery or chronic pancreatitis, and cancers of the pancreas, bile duct or gallbladder. Finding the cause quickly matters, and most blockages can be relieved through an endoscope.
Symptoms
- Yellow eyes and skin
- Itching all over the body
- Dark, tea-coloured urine and pale, clay-coloured stools
- Pain in the upper belly, or no pain at all
- Fever with chills if the bile becomes infected
Common causes
Painless jaundice that keeps deepening, especially with weight loss in someone over 50, needs urgent tests to rule out cancer.
- Stones in the bile duct
- A narrowing (stricture) after gallbladder surgery or from chronic pancreatitis
- Cancer of the head of the pancreas, the bile duct or the gallbladder
- Swollen lymph nodes or, less often, parasites
Tests
Liver blood tests show the pattern of a blockage. An ultrasound shows widened bile ducts. MRCP, CT or EUS then finds the exact cause and place of the blockage, and EUS or ERCP can take samples from a narrowing.
Treatment
Itching and jaundice usually improve within days to weeks once bile is draining. Keep stent change dates, as blocked stents can cause infection.
- ERCP: stones are removed and a plastic or metal stent is placed across a narrowing to drain bile
- EUS-guided drainage when ERCP is not possible
- Drainage through the skin by a radiologist (PTBD) in some cases
- Surgery for some cancers and some narrowings
Diet with a blocked bile duct
Eat more
- Small, frequent, lower-fat meals: khichdi, dal-rice, roti-sabzi, curd, fruits
- Protein from dal, paneer, eggs and fish to maintain strength
- Plenty of fluids, especially before and after ERCP
Cut down
- Fried food, rich gravies, cream and butter while jaundiced, as fat is poorly digested
- Alcohol
- Herbal or home remedies for jaundice, which can delay the right treatment
Good to know
- Sugarcane juice, radish leaves or avoiding turmeric do not open a blocked duct; only treating the blockage does.
- Once bile drains, a normal diet can be resumed.
Common questions
Is this jaundice the same as hepatitis?
No. In hepatitis the liver itself is inflamed. In obstructive jaundice the liver is working but bile cannot drain out. The treatment is to open the blockage.
How quickly does jaundice clear after a stent?
Itching often improves within days, and the yellow colour fades over 2 to 6 weeks, depending on how high the bilirubin was.
What is the difference between plastic and metal stents?
Plastic stents are cheaper and are changed every few months. Metal stents stay open longer and are mostly used for narrowings caused by cancer.