Biliary Drainage And Biliary Stenting

The bile ducts are small tubes in the liver that transport bile  , they are too small to be seen on normal scans.

When obstructed , the symptoms are not only horrible but life threatening too.

Symptoms Of Biliary System Obstruction

  1. Yellowing Of Eyes and skin  (Jaundice) , commonest.
  2. General body Itching ; the itching is so intense that it affects the quality of life including sleep , on a sad note this itching does not respond to  the best itching medications available in the world.
  3. Dark coloured urine
  4. Pale / clay colored stool
  5. Fever
  6. Easy bruising
  7. Weight loss
  8. Vague Abdominal (tummy ) pain , particularly the right upper side.
  9. Altered Mentation State / Psychosis ; Seen in terminal disease.
Yellow Eyes And Skin ( Jaundice)

Treatment Of Biliary Obstruction

  1. Biliary Drainage.
  2. Biliary Stenting.

Percutaneous Transhepatic Biliary Drainage ( PTBD)

Percutaneous transhepatic biliary drainage ( PTBD)  means that your insert a small tube from the skin (overlying the liver) , across the liver into the bile pipes , so that you can drain the stuck bile!

A schematic image of a bile drainage tube across skin , liver into the biliary system

Below is a patient with a bile system drain

Yellow shows a catheter from skin , through liver into the bile pipe ( duct) ,you can see dark bile draining.

A successful bile drainage ( PTBD) brings great symptom relief allowing patient to stabilise and get more definitive treatment , if any or life long palliation.

Biliary Stenting

The use of a catheter to drain the biliary system is alway more than welcome in patient with horrible symptoms of bile system obstruction..

The external part of bile system drainage catheter

Common Issues With Bile System Catheters

  1. Leakage around the catheter making the catheter dressings wet.
  2. Bleeding around the catheter.
  3. Pain.
  4. Catheters can get blocked.
  5. Catheters can accidentally jump out of the bile system.
  6. Catheter can get infected.
  7. Discomfort , no one wants something hanging outside their body.

So for obvious reasons now , we at times don’t want to leave the patient with a catheter for a long time.

So we can replace the catheter with a stent , same route of skin, through liver , into biliary system.

This procedure is called percutaneous transhepatic biliary stenting.

What is a stent ?

A stent is tiny round mesh like pipe that is used to open up any blocked channel in the body.

It is reasonable to imagine a stent as a culvert.

The culverts keep road channels of interest open , in the body we use stents to achieve the same.

The body stents are of different types depending on where it is going to be used , the world’s most expensive body stents are those meant for the brain.

Below is a photo of a stent used in the body

A Stent that can be used in a human body

Below you can make out a stent inside the bile system.

Biliary system stenting

Below is a stent inside the bile system of a patient.

Once a stent is placed inside the biliary system , we can then do away with a catheter.

There is more to the bile system we do that needs space , but i honestly feel that what is already shared is a good starting point.

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