Understanding Your Gallbladder & Biliary System

Your gallbladder and bile ducts are located in your right upper abdomen. The bile duct and hepatic ducts (biliary system), transport bile from your liver into the intestine. Bile helps with digesting fat. The gallbladder stores bile.

PROBLEMS WITH YOUR GALLBLADDER AND BILIARY SYSTEM

Cholecystitis and Cholangitis

About Cholecystitis and Cholangitis

What are cholecystitis and cholangitis?

Cholecystitis is the inflammation and infection of the gallbladder, which occurs in some patients with gallstones . Cholangitis is an infection of the bile duct, which can occur, when the bile duct is blocked by a gallstone.

What are the signs and symptoms of cholecystitis and cholangitis?

Cholecystitis and cholangitis can present with fevers, chills, low blood pressure and pain in the right upper abdomen. If the bile duct is blocked with a gallstone, the patient might also have jaundice (yellowing of the eyes and skin).

Why do I get cholecystitis and cholangitis?

Some people are more prone to having gallstones , which can block the gallbladder duct (cystic duct) or bile duct, and cause inflammation and infection. In rare instances sick patients in the hospital have cholecystitis without gallstones. Rarely, patients can also form stones in the bile duct or hepatic duct, which can cause a blockage.

Diagnosis of Cholecystitis and Cholangitis

How are Cholecystitis and Cholangitis diagnosed?

If you have symptoms of cholecystitis or cholangitis, your doctor may order blood tests or scans of your abdomen. Sometimes you may also need a procedure.

Blood tests

  • Your doctor may check blood tests to look for an infection and check he function of your liver to look for a blockage of your bile duct.

Imaging

  • Abdominal Ultrasound to look for an infection of your gallbladder and or a blockage of your bile duct.
  • CT or MRI scan of your belly (or of the abdomen and pelvis) to look for an infection of your gallbladder and or a blockage of your bile duct.

Procedures

  • An Endoscopic Retrograde Cholangiopancreatography (ERCP) can find and remove gallstones that cause cholangitis.

Treatment of Cholecystitis and Cholangitis

How is Cholecystitis and Cholangitis treated?

  • Hospital admission and supportive care
  • Surgery for Cholecystitis and Cholangitis

Hospital Admission

Patients with Cholecystitis and Cholangitis will be admitted to the hospital, and treated with intravenous fluids, antibiotics and pain medications.

Surgery and Procedures for Cholecystitis and Cholangitis

Patients with Cholecystitis need to have their gallbladder removed surgically ( cholecystectomy ). Patients with cholangitis will have an endoscopic procedure called ERCP to remove the gallstone from the bile duct. Since the gallbladder is the most likely source of gallstones, patients will need a cholecystectomy after their acute cholangitis has resolved.

Gallbladder and Bile Duct Cancer

About Gallbladder and Bile duct Cancer

What is gallbladder and bile duct cancer?

Gallbladder cancer is a cancer in that occurs in the wall of the gallbladder. Bile duct cancer (cholangiocarcinoma) arises from the wall of the liver ducts. It can occur in the liver or in the ducts connecting the liver to the intestine.

There are 3 different types of cholangiocarcinoma:

  • Distal bile duct cancer: occurs in close the where the bile duct meets the bowel
  • Hilar bile duct cancer: occurs in the bile duct between the liver and intestine
  • Intrahepatic bile duct cancer: occurs in the small bile ducts in the liver

What are the signs and symptoms of gallbladder and bile duct cancer?

Gallbladder and bile duct cancer is often silent in early stages. Patients may present with:

  • Abdominal and back pain
  • Poor appetite, nausea, vomiting, weight loss

More advanced stages can present with:

  • Jaundice (yellow skin and eyes)
  • Clay-colored stools and dark urine
  • Abdominal and back pain
  • Poor appetite, nausea, vomiting, weight loss
  • Jaundice (yellow skin and eyes)
  • Bowel blockage
  • High blood sugars and Diabetes

What is my risk for getting gallbladder and bile duct cancer?

Increased risk for gallbladder cancer

Gallbladder cancer is more common in older women.

  • History of gallstones and chronic infection of the gallbladder (cholecystitis)
  • Gallbladder polyps

Increased risk for bile duct cancer (cholangiocarcinoma)

  • Smoking and old age
  • Primary sclerosing cholangitis is a disease of the bile ducts, which causes narrowing of the ducts.
  • Absent or abnormal liver or bile ducts at birth
  • Cysts of the bile duct
  • Chronic liver disease
  • Infections with a liver parasite

Diagnosis of Gallbladder and Bile duct Cancer

How is gallbladder and bile duct cancer diagnosed?

If you have any symptoms of gallbladder or bile duct cancer, your doctor may order blood tests and pictures (imaging) of your belly. You may also need a biopsy to confirm the diagnosis.

Blood tests

  • Complete blood count (CBC) to check your blood count.
  • Comprehensive Metabolic Panel (CMP) to check your electrolytes and liver function.
  • Ca19-9 and CEA levels. These blood tests are called “tumor markers,” and will give your doctor a chance to follow your response to treatment.

Imaging

  • CT or MRI scan of your belly (or of the abdomen and pelvis) to look for a mass in the gallbladder or liver. A special MRI called MRCP will show your surgeon if there is a blockage in your bile ducts. These tests will allow your doctor to evaluate, if your tumor can be removed with surgery.

Procedures

  • Endoscopic Ultrasound (EUS): Your doctor inserts a camera into your intestines through your mouth, so your bile ducts can be seen.
  • An Endoscopic Retrograde Cholangiopancreatography (ERCP) is another form of endoscopy that allows your doctor to place a stent into the bile duct for patients with jaundice. During this procedure. the doctor will be able to get bile duct cells, which are used for diagnosis. This can be done at the same time as the EUS.
  • Percutaneous Biopsy: If there is a mass in the liver or a large lymph node in the area, your doctor might order a biopsy, which is done by a radiologist. The radiologist will use ultrasound or CT scan to find the tumor or biopsy.

Treatment of Gallbladder and Biliary Cancer (Cholangiocarcinoma)

How is gallbladder and biliary cancer treated?

The treatment of gallbladder and bile duct cancer depends on the stage of the tumor, and involves a multidisciplinary team of doctors, nurses and medical support staff:

  • Medical Oncology
  • Gastroenterology
  • Surgery
  • Radiation
  • Dietary and Social work, Palliative care.

Every patient seen here will be presented in our Multidisciplinary Tumor Board , where we will devise your individual treatment plan. This plan may include:

We strongly encourage and support all of our patients to participate in clinical trials. We are happy to talk to you about clinical trials during your clinic visit.

Bile Duct (Choledochal) Cysts

Bile Duct Cysts

What are choledochal (bile duct) cysts?

Bile duct cysts are abnormalities in the tubes connecting liver to the intestine. The bile ducts enlarge like balloons anywhere along their course towards the small bowel. There are different types of bile duct cysts, depending on where the ballooning occurs.

What are the signs and symptoms of bile duct cysts?

Choledochal cysts are usually diagnosed in children, but sometimes not recognized until adulthood. The may present as:

  • Intermittent pain in the right upper abdomen
  • Yellowing of the eyes and skin (Jaundice)
  • Inflammation of the bile duct (cholangitis)
  • Clay-colored stools and dark urine

What are my risks for having bile duct cysts?

Bile duct cysts are congenital, which means that they have been present since birth, and might not get recognized until adulthood.

They can cause repeated infection and can turn into cancer.

Diagnosis of Bile duct Cysts

How are bile duct cysts diagnosed?

If you have any symptoms of a bile duct cyst, your doctor may order blood tests and pictures (imaging) of your belly. You may also need a biopsy to confirm the diagnosis

Blood tests

  • Complete blood count (CBC) to check your blood count.
  • Liver function tests
  • Ca19-9 and CEA levels. These blood tests are called “tumor markers,” and will give your doctor assess that your cyst is not cancer.

Imaging

  • The first picture (imaging study) of your abdomen is usually ultrasound, which can identify bile duct cysts.
  • CT or MRI scan of your belly (or of the abdomen and pelvis) will let your doctor look at the anatomy of the bile ducts. A special MRI called MRCP will provide important details about the location and size of your bile duct cysts.

Procedures

  • Endoscopic Ultrasound (EUS): Your doctor inserts a camera into your intestines through your mouth, so your bile ducts can be seen.
  • An Endoscopic Retrograde Cholangiopancreatography (ERCP) is another form of endoscopy that allows your doctor to place a stent into the bile duct for patients with jaundice. During this procedure, the doctor will be able to get bile duct cells, which are used for diagnosis. This can be done at the same time as the EUS.

Treatment of Bile duct Cysts

How are bile duct cysts treated?

Bile ducts cysts will always be removed with surgery. The type of surgery depends on the location of the cyst.

If the cyst is the part of the bile duct outside the liver and pancreas, the patient will need a bile duct excision and reconstruction .

If the bile duct cyst is not part of the main bile duct, it will be removed without removing and reconstructing the main bile duct.

If the cyst is in the part of the bile duct, which runs through the pancreas, the patient will need a Whipple Procedure .