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What does a blockage in bile duct indicate?

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Internal Medicine Specialist
Practicing since : 2009
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Please help me I am out of my mind with worry. I had my gallbladder removed by laprascopic cholecystectomy 18 months ago. I recovered well after this. Unfortunately I have started with similar pain again and was sent for an ultrasound scan which has found a blockage in my bile duct and a fatty liver. I am worried to death the blockage is a tumour. I am being sent for a MRI scan waiting for the appointment. If it was some kind of tumour would the scan be done much quicker? Can they tell on the ultrasound scan if it is a tumour. Please help me asap I am sat here in a state crying.
Posted Mon, 3 Mar 2014 in Abdominal Pain
 
 
Answered by Dr. Anshul Varshney 20 minutes later
Brief Answer: seems to be CBD Stone. Detailed Answer: Dear XXXXXXX Hi , I am Dr Anshul Varshney , I have read your query in detail , I understand your concern. You are worrying excessively. A blockage in bile duct is mostly due stone to Common Bile Duct (CBD) (If left intact during your GB removal surgery). Some times , a stone is there in CBD , which was missed during your GB Removal surgery , which can now precipitate this problem. This can be treated easily with surgery. I suppose MRI that you are talking about is Magnetic resonance cholangiopancreatography, a technique to visualise the biliary tract and pancreatic ducts. It is a wonderful technique to diagnose such conditions. I don't understand why are you worrying about cancer. Has any doctor told you that he is suspecting it? If possible please attach your Ultrasound report. I will tell you frankly that what it is suggestive of. And about Fatty Liver , i can assure you one thing that it is not cancer. Fatty Liver can be found in following conditions : 1. Alcholic Liver Disease (Initial Stage) 2. Non Alcoholic Fatty Liver Disease. We can evaluate that with a fibroscan or liver biopsy , if indicated. If you have not got your Liver Function tests done , do get them. Also if you have severe pain abdomen , you should also get your Serum Amylase and Lipase to rule out Acute Pancreatitis , which can be a complication of Common Bile Duct Stone. XXXXXXX , what picture i am getting here is that you simply have a CBD Stone. You need not cry , need not worry. It is completely treatable. Just attach all reports that you have for a better comment. This is my personal opinion based on details available here. If you still have any query you may please ask me. Stay Healthy. Dr Anshul Varshney , MD
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Follow-up: What does a blockage in bile duct indicate? 4 minutes later
Thank you very much. I do not have the report of ultrasound scan. I never drink alcohol at all so what can i do about my fatty liver? I am overweight and trying to lose weight. Can I be put under GA if I have to have stone removed as I am not brave and worry so much. I always worry about cancer it scares me so much that I am going to get it. I have had no liver tests or anything done Doctor has not suggested this. I am due to go on holiday in 6 weeks to Spain, am I safe to go if I have this stone?
 
 
Answered by Dr. Anshul Varshney 10 minutes later
Brief Answer: Detail Follows Detailed Answer: Dear XXXXXXX If you don't drink alcohol , it can be Non Alcoholic Fatty Liver Disease. You should take low fat diet and should loose weight. Get Liver Function Tests done , if deranged , further investigations like Fibroscan , Liver Biopsy are required. If Liver Functions are normal , we usually leave it as such. However , rarely it can progress to Cirrhosis , that's why if Liver Function Tests are also disturbed , we recommend further testing. Right now , i am not sure that it is CBD Stone or not. You are soon going for MRCP , so nothing to worry , your diagnosis would get clear after that. In case you are found to have stone , you should avoid going to Spain before surgery as the stone can aggravate severe pain and acute pancreatitis during your trip. If you don't have a stone , and just fatty liver , you can happily go for your holiday. Many times , fatty liver also causes some kind of dragging pain in abdomen. So , get MRCP , if your doctor is suggesting that after your Ultrasound , and be sure. Regarding surgery , things can be decided once reports are available. You can talk to me again when you have your reports , i will guide you about the further management and surgery if required under GA or not. So , don't cry , just smile , be happy :) If you don't have a further query , you may please close the discussion and rate it.
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Follow-up: What does a blockage in bile duct indicate? 9 minutes later
In first reply you thought it was a stone in second reply you not sure. I have regular blood tests and all tests are fine regarding liver, pancreas etc. What do you think is wrong if it is not a stone. I am currently overweight but I am losing weight. I weigh 17stone was 17stone 12 pound before
 
 
Answered by Dr. Anshul Varshney 10 minutes later
Brief Answer: Detail Follows Detailed Answer: Dear XXXXXXX How can i be sure with out seeing your reports. I just told you what diagnosis it was evident from your query. By saying that you have blockage in your bile ducts , diagnosis can be : 1. CBD Stone 2. Primary Sclerosing Cholangitis. 3. Pancreatitis. Mostly , it is due to CBD Stone. And none of these conditions i can make out from available details is Cancer. To tell you exactly how overweight you are , i need to know you Height also , so that i can calculate your Basal Metabolic Index (BMI). In any case , you realize that you are over weight and working out for it. I appreciate. Stay Healthy.
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Follow-up: What does a blockage in bile duct indicate? 6 minutes later
Sorry I was just a bit confused if it is number 1,2 or 3 can they be treated. I am 5 foot 3 inches can you please also tell me what my weight should be. Thank you I appreciate you taking the time to talk to me
 
 
Answered by Dr. Anshul Varshney 14 minutes later
Brief Answer: Detail Follows Detailed Answer: Dear XXXXXXX I meant that these are the 3 main possibilities with the available information. 1 and 3 can be treated very well with medical or surgical management. Primary Sclerosing Cholangitis can not be treated completely , but we can control it's progression to some extent. Again , none of them is a Cancer. As per your weight and height your BMI is 42.2 , means you are overweight. BMI Categories: Underweight = <18.5 Normal weight = 18.5–24.9 Overweight = 25–29.9 Obesity = BMI of 30 or greater You need to loose a lot , if we go ideally around 40 kgs :( Try Hard , you will surely loose.
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Follow-up: What does a blockage in bile duct indicate? 9 minutes later
Thank you I going to try very hard to lose weight. I am going to get report off doctor tomorrow, I will send this to you and then close discussion, hope this is ok with you. Many thanks
 
 
Answered by Dr. Anshul Varshney 2 minutes later
Brief Answer: No Problem Detailed Answer: No Problem Dear XXXXXXX I would be happy to see your reports and help you further. Good Luck.
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Follow-up: What does a blockage in bile duct indicate? 1 hour later
PLease find my scan report
 
 
Answered by Dr. Anshul Varshney 9 minutes later
Brief Answer: CBD Dilated. MRCP Indicated. Detailed Answer: Dear XXXXXXX I studied your ultrasonography report. As we discussed based on your history , your ultrasound report is suggestive of Fatty Liver and CBD Dilatation. This can be due to stones. Many times , stones are in distal part of CBD , so are not visualized on ultrasound. You are a perfect candidate of MRCP , about which i told you in my first answer. Go ahead with MRCP , we will get sure that there is a stone or not. I would also like to know the following : 1. Description of your pain : Site , Frequency , Radiation , Duration. 2. Any Yellow discolouration of eyes or urine? 3. Any history of clay coloured stools? 4. Any Itching? By asking these questions i am just trying to rule out if you have Obstructive Jaundice due to stone in CBD. I also strongly recommend you to go for MRCP and also get your Liver Function Test done. Good Luck.
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Follow-up: What does a blockage in bile duct indicate? 3 minutes later
what if it is not a stone? what is it? Upper left abdomen sharp then dull ache, with a stab going through to my back every other day, always discomfort in upper left abdomen No yellow, clay stools or itching What is an MRCP?
 
 
Answered by Dr. Anshul Varshney 19 minutes later
Brief Answer: Detail Follows. Detailed Answer: Dear XXXXXXX There are numerous causes of CBD Dilatation. Most common being CBD Stone. But other causes you can not really rule out based on information available here. For your information , i am listing down the causes of CBD Dilatation : 1. Stone in CBD- responsible for majority of cases 2. Inflammation of bile ducts 3. Trauma 4. Biliary strictures (abnormal narrowing of the ducts) 5. Cysts 6. Enlarged lymph nodes 7. Pancreatitis 8. Injury related to gallbladder or liver surgery 9. Tumors of bile ducts 10. Tumors of pancreas 11. Parasites. MRCP is Magnetic resonance cholangiopancreatography, a technique to visualise the biliary tract and pancreatic ducts. I am sure , that your doctor might have used the term MRI for MRCP only. Your symptoms are not suggestive of jaundice , but the pain you are describing occurs in Pancreatic Problems. However , no mass repeated in pancreas. But a hypoechogenecity is reported. It requires evaluation. Stop worrying , just request your doctor to give you an early appointment in view of your ongoing pain and uncertainity of the diagnosis. Do share my opinion with him. I am sure he would agree to this.
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Follow-up: What does a blockage in bile duct indicate? 13 minutes later
Thank you but you really do not feel it is cancer?
 
 
Answered by Dr. Anshul Varshney 5 minutes later
Brief Answer: Needs Proof Detailed Answer: Dear XXXXXXX Giving such a statement that you have a cancer needs proofs. No doctor can really say this without a proof. And it's not that it can't be a tumour (cancer) , but currently we have very insufficient evidence to comment on it. I just wish and pray for you that it's not cancer. I really can't comment at present. Follow me with your LFT , Amylase , Lipase and MRCP. I would be happy to help you again. Good Luck.
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Follow-up: What does a blockage in bile duct indicate? 1 hour later
I go on holiday to Tenerife in 6 weeks should I cancel?
 
 
Answered by Dr. Anshul Varshney 8 hours later
Brief Answer: MRCP first Detailed Answer: Just get your MRCP done. If it is clear you can go on your holiday. And if not , it would depend upon what the result is and how agressivly it has to be treated. Review with reports.
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Follow-up: What does a blockage in bile duct indicate? 6 hours later
The following sentence really worries me. You don't think it is cancer do you? Also there is a doubtful area in the head of the pancreas which has been described as subtle. This is a limitation on ultrasound and needs further imaging by CT scan or MRI scan
 
 
Answered by Dr. Anshul Varshney 13 minutes later
Brief Answer: Detail Follows Detailed Answer: Dear XXXXXXX I am again saying that with the available reports , it would be really difficult to comment upon that it is a cancer or not. I understand your worry , as any person would get tensed hearing about that. But , the ultrasound report about pancreas is very vague , it creates a doubt in my mind too, but again , without a strong evidence , i can not really comment that it is a cancer or not. Only thing that is making me worried is that you have undergone cholecystectomy earlier , so chances of CBD Stone are there , if they have been missed earlier. In first instance , hearing your query , one would say that it can be due to a CBD Stone. But when you shared your Ultrasonography report with me , in which it is mentioned that there is a subtle hypogenicity in your pancreas , it creates a doubt. It can be a simple cyst in pancreas , or it can be a collection over there , it can be pseudocyst. But yes , it can be a cancer too. There is really very little evidence to support the diagnosis of cancer. I hope you understand. Also , MRI is required to reach to the diagnosis further. Since you have been already suggested for MRCP , it would help in making the diagnosis. When is your MRCP planned?
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Follow-up: What does a blockage in bile duct indicate? 27 minutes later
It is not planned yet I am still waiting got to see a Gastroenterologist first this is what is worrying me
 
 
Answered by Dr. Anshul Varshney 4 minutes later
Brief Answer: Detail Follows Detailed Answer: Dear XXXXXXX I know you are worried. I have given you the best possible guidance with the available details. Get appointment with Gastroenterologist as soon as possible. Would really like to hear from you again with your MRCP Report. Good Luck.
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