Biliary Tree

What is your biliary tree?

Your biliary tree is the network of organs and vessels that make, store and move bile through your body. It’s also called the biliary tract or biliary system. It looks like a tree, with many small branches that come together. These branches are your bile ducts. The organs include your liver (which makes bile), your gallbladder (which stores bile) and your small intestine (where bile ends up).

What does your biliary system do?

Your biliary tree helps your digestive system. It carries bile and enzymes from your pancreas to your small intestine to break down food. Bile also removes waste. When your liver makes bile, it adds waste products it filtered from your blood. These waste products leave your body in your poop.

Where is your biliary tree located?

The parts of your biliary system sit in your upper belly, between your ribs and belly button. Your liver is on the top right, your gallbladder is tucked under your liver and your stomach is in the middle. Your pancreas, which connects to your biliary tree, lies behind your stomach. The first part of your small intestine sits just below your stomach.

What are the parts of your biliary tree?

Your biliary tree includes:

• Liver: This makes bile and adds waste products, cholesterol and bilirubin. It also makes bile acids (bile salts) from cholesterol, which your small intestine needs for digestion.
• Bile ducts: These small tubes collect bile from the liver and carry it to other organs. They join together to form the common bile duct, the “trunk” of the tree.
• Gallbladder: This stores some bile from your liver. When your small intestine needs more bile, your gallbladder releases it into the common bile duct.
• Pancreas: This releases digestive enzymes into the pancreatic duct. This duct connects with the common bile duct. Together, they empty into your small intestine through the ampulla of Vater.
• Small intestine: Bile enters at the duodenum, the first section. Bile acids break down food here. Some acids go back into your bloodstream and return to your liver. The rest pass into your large intestine with other waste.

What common conditions and disorders can affect your biliary tract?

Since the organs and ducts are linked, problems in one can affect the others. Infections and inflammation can spread through the bile ducts. Blockages can stop bile from flowing. Common conditions include:

• Gallstones: These can block bile flow, cause pain, and lead to infections.
• Cholestasis: This is slow or stopped bile flow, often from problems making bile. It can happen during pregnancy.
• Biliary stricture: Scar tissue narrows the bile ducts, making it hard for bile to flow. Cancer or autoimmune disease can cause this.
• Liver disease: Long-term liver damage leads to scarring that affects bile production.

Other conditions include:

• Ampullary cancer
• Bile acid malabsorption
• Bile duct cancer
• Biliary dyskinesia
• Chronic pancreatitis
• Gallbladder cancer
• Liver cancer
• Pancreatic cancer
• Primary sclerosing cholangitis
• Primary biliary cholangitis

What are common signs and symptoms of biliary tract disease?

Some important warning signs and symptoms of biliary tract disease include:

• Jaundice: Yellow skin and eyes when bile backs up into your blood
• Upper abdominal pain: May come from your liver, gallbladder, or bile ducts
• Biliary colic: Severe pain from a gallbladder blockage, often with nausea and vomiting
• Fatty stools (steatorrhea): If bile can’t break down fats, stools may be pale, greasy, or float

What kinds of medical tests can check the health of my biliary tree?

If you have symptoms, your provider may order blood tests and imaging tests. Blood tests check liver and pancreas enzymes. Imaging tests, like ultrasound or CT scan, look for blockages or swelling. Other specialized tests include:

• Endoscopic ultrasound (EUS)
• Hepatobiliary scintigraphy (HIDA scan)
• Magnetic resonance cholangiopancreatography (MRCP)
• Endoscopic retrograde cholangiopancreatography (ERCP)

What are some common medical treatments for biliary tract conditions?

Possible treatments for biliary tract disease include:

• Biliary drainage: A small tube drains extra bile from your ducts through the abdominal wall.
• Endoscopic treatment: During an ERCP, a provider can remove a blockage, take a tissue sample or place a stent.