Biliary Tract

What is your biliary tract (biliary system)?

Your biliary tract, or biliary system, is the network of organs and vessels that make, store and transfer bile through your body. Bile is a fluid your liver makes that helps digest your food. Tiny canals called bile ducts connect your liver, gallbladder and pancreas to your duodenum, the top of your small intestine.

What is the function of the biliary tract?

Your biliary tract plays an important role in your digestive system. It delivers bile and pancreatic enzymes to your duodenum to help break down and absorb the nutrients in your food. Bile also carries waste products. Your biliary tract enables your body to dispose of this waste through your intestines.

Where is your biliary system located?

The organs and ducts that make up your biliary system live in your upper abdominal cavity. Your liver, which makes bile, is at the top on the right. Your gallbladder is tucked underneath your liver, close to your stomach. Your pancreas lies behind your stomach, and your small intestine lies underneath.

What are the different parts of your biliary system?

Your biliary system includes your:

• Liver. Your liver makes bile while filtering your blood, sorting excess cholesterol and bilirubin together with other waste products. Bile also contains bile acids, which your liver makes from cholesterol. These acids are what your small intestine needs to help with digestion. Your liver collects the bile into tiny bile ducts inside it (intrahepatic ducts), which connect to larger branches outside of it (extrahepatic ducts).
• Bile ducts. Your bile ducts collect bile where it’s created in your liver and carry it to the other organs in your biliary tract. All branches lead to the common bile duct, the main trunk of the biliary tree, which leads to your duodenum. The common bile duct connects to your liver through the common hepatic duct, to your gallbladder through the cystic duct, and to your pancreas through the pancreatic duct.
• Gallbladder. While half of the bile that comes from your liver goes straight to your common bile duct and duodenum, the other half goes to your gallbladder for storage. Your gallbladder saves and condenses the bile until it’s needed. When your small intestine detects that it has fats and proteins to break down, it signals to your gallbladder to contract and release an extra dose of bile into the ducts.
• Pancreas. Your pancreas also responds to the signal from your duodenum. It releases a cocktail of enzymes that help break down carbohydrates, proteins and fats into the pancreatic duct. The pancreatic duct connects with your common bile duct, where it meets your duodenum. This joint duct, which acts as a reservoir for incoming bile and enzymes, is sometimes called the ampulla of Vater.
• Small intestine. Your duodenum is the connection point between your biliary tract and your gastrointestinal tract. After bile enters your small intestine, the bile acids are extracted from the rest, which passes as waste through your poop. The bile acids help break down fats in your intestine. Then, they’re reabsorbed through your intestinal wall into your blood, where they recycle back to your liver.

What common conditions and disorders can affect your biliary tract?

The organs and vessels that make up your biliary tract are closely connected, so disease in one can easily affect the others. Infections and inflammation can spread through your bile ducts to nearby organs. Conditions that block or stall the flow of bile through your ducts can also affect the whole system.

Some common biliary tract diseases include:

• Gallstones. A gallstone stuck in your bile ducts, especially in your common bile duct, is a leading cause of biliary pain and disease, including gallbladder inflammation and gallstone pancreatitis.
• Cholestasis. Cholestasis is when the flow of bile slows or stalls. It could be because your liver is having trouble producing bile, or because your bile ducts are obstructed in some way.
• Biliary stricture. Chronic inflammation in your bile ducts can cause scar tissue to build up, restricting and narrowing the ducts. This is often due to hereditary or autoimmune diseases.
• Liver disease. Chronic liver disease eventually leads to scarring in your liver tissues (cirrhosis), which can interfere with their functioning. This can prevent your liver from making enough bile.

Other diseases include:

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

What are common signs and symptoms of biliary tract disease?

Common symptoms of biliary tract disease include:

• Jaundice. Jaundice is when your skin and eyeballs turn yellow. It happens when bile backs up in your biliary tract and leaks into your bloodstream. Bile gets its yellow color from bilirubin.
• Biliary colic. Biliary colic is a cycle of pain that’s triggered when your gallbladder contracts to release bile into your common bile duct. It occurs after eating, builds to a peak and then fades.
• Nausea and vomiting. Nausea and vomiting commonly occur with biliary colic, and they can also occur as more chronic symptoms, along with jaundice. Bile toxins in your blood can cause them.
• Fatty stools (steatorrhea). If bile or bile acids aren’t making it into your small intestine for some reason, you’ll have trouble breaking down and absorbing fats. They’ll pass in your poop instead.

Other possible symptoms include:

• Upper abdominal pain.
• Dark-colored urine.
• Confusion or mild cognitive impairment.

What medical tests can check the health of my biliary tract?

If you have any of the above symptoms, your healthcare provider might investigate with:

Blood tests. Liver function tests and pancreas function tests look for high levels of liver enzymes or pancreatic enzymes. A complete blood count might show high white blood cells, a sign of inflammation.

Imaging tests. Basic imaging tests like an abdominal ultrasound or CT scan can help locate a blockage or swelling in your biliary tract. Specialized imaging techniques can focus more closely on your biliary tract.

Specialized imaging tests for your biliary tract 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. This simple procedure helps drain excess bile from your bile ducts. A healthcare provider inserts a small catheter into your biliary tract through your abdominal wall.
• Endoscopic treatment. During an ERCP, a healthcare provider can access your biliary tract with tools through the endoscope. They can remove a blockage, take a biopsy or place a stent.

What can I do to keep my biliary tract healthy?

A healthy lifestyle goes a long way toward keeping your biliary tract healthy. For example:

• Maintain a healthy diet. Emphasize whole foods over processed foods, and limit sugar and saturated fats to keep your liver healthy and your cholesterol at healthy levels. Excess cholesterol can lead to gallstones and fat storage in your liver (fatty liver disease).
• Use drugs and alcohol in moderation. Alcohol use and overuse of common, over-the-counter drugs are leading causes of gallstones and liver disease. If you have biliary tract disease for any reason, these substances can make it worse. Give your liver a chance to detox between use.
• Get your wellness checkups. Biliary tract disease can go unnoticed for a long time. Keeping up with your healthcare checkups improves your chances of recognizing diseases earlier. You can also review your medications with your provider to make sure they aren’t hurting your liver.