Chapter 35 - Diseases of the Bile Ducts

Abstract

Disorders of the biliary tract often manifest with symptoms and signs related to obstruction, including pain, jaundice, pruritus, fever, and abnormal liver biochemical test levels. The most common condition is choledocholithiasis, which can result in a number of direct and indirect consequences, including cholangitis and pancreatitis. Making a diagnosis can be straightforward in patients who present with classic symptomatology. However, biliary stone disease can have a spectrum of presentations, including absence of symptoms, in which case cross-sectional imaging plays an important role in diagnosis. Strictures can also cause obstruction, and, although the majority are concerning for malignancy, a number of benign entities need to be considered, such as primary sclerosing cholangitis and immunoglobulin G4-related disease. Finally, with advances in technology, a variety of premalignant and early malignant lesions of the biliary tract have been recognized, including biliary intraepithelial neoplasia and biliary intraductal papillary neoplasms. In all of these conditions, endoscopic retrograde cholangiopancreatography, along with cholangioscopy and other advanced imaging techniques, plays an important diagnostic and therapeutic role.