BILIARY STRICTURES

**BILIARY STRICTURES **

Biliary strictures are abnormal narrowings of the biliary ducts that can lead to obstruction of bile flow.

Types of Biliary Strictures:

1. Primary biliary strictures: These are caused by chronic inflammation and fibrosis of the biliary ducts.
2. Secondary biliary strictures: These occur as a result of obstruction or injury to the biliary ducts, leading to chronic inflammation and fibrosis.

Causes of Biliary Strictures:

1. Chronic pancreatitis: Inflammation and scarring of the pancreas can lead to narrowing of the biliary ducts.
2. Gallstones: Large stones can block the biliary ducts and cause inflammation and scarring.
3. Benign biliary strictures: These are narrowings of the biliary ducts that are not caused by cancer or gallstones.
4. Malignant biliary strictures: These are narrowings of the biliary ducts caused by cancer.
5. Iatrogenic strictures: These occur as a result of medical procedures, such as ERCP or open surgery.

Pathophysiology:

1. Obstruction of bile flow: Biliary strictures can block the flow of bile from the liver to the small intestine.
2. Chronic inflammation: The obstruction of bile flow can lead to chronic inflammation and scarring of the biliary ducts.
3. Fibrosis: The chronic inflammation and scarring can lead to the formation of fibrotic tissue, which can narrow the biliary ducts.

Clinical Features:

1. Jaundice: Yellowing of the skin and eyes due to elevated bilirubin levels.
2. Dark urine: Bilirubin can cause the urine to appear dark or tea-colored.
3. Pale stools: Bile salts are not present in the stool, which can cause it to appear pale.
4. Abdominal pain: Pain in the upper right or middle abdomen.
5. Weight loss: Loss of appetite and weight due to malabsorption of nutrients.

Investigations:

1. Ultrasound: Can show gallstones, bile duct dilatation, and liver disease.
2. CT scan: Can show bile duct dilatation, liver disease, and pancreatic disease.
3. MRCP (Magnetic Resonance Cholangiopancreatography): Can show bile duct anatomy and strictures.
4. ERCP (Endoscopic Retrograde Cholangiopancreatography): Can show bile duct anatomy and treat strictures.

Complications:

1. Cholangitis: Infection of the biliary tract.
2. Liver abscess: Collection of pus in the liver.
3. Secondary biliary cirrhosis: Scarring of the liver due to chronic bile duct obstruction.
4. Cholangiocarcinoma: Cancer of the biliary tract.

Management:

1. ERCP: Can be used to dilate strictures and place stents to restore bile flow.
2. Percutaneous transhepatic cholangiography (PTC): Can be used to treat strictures and restore bile flow.
3. Surgical intervention: May be necessary to treat strictures that are not amenable to ERCP or PTC.

Homoepathic Therapeutic Medicines:

1. Chelidonium: Indicated for liver and gallbladder problems.
2. Lycopodium: Indicated for liver and pancreas problems.
3. Sulfur: Indicated for liver and gallbladder problems.

Step-wise sequence of ERCP:

1. Endoscope insertion: The endoscope is inserted through the mouth and guided through the stomach and small intestine to reach the bile ducts.
2. Cannulation of the bile ducts: A catheter is inserted through the endoscope and guided into the bile ducts.
3. Contrast injection: A contrast agent is injected through the catheter to visualize the bile ducts.
4. Stricture dilation: The stricture is dilated using a balloon or other device.
5. Stent placement: A stent is placed to restore bile flow.

Blood Supply of the Bile Ducts:

1. Hepatic artery: Supplies blood to the bile ducts.
2. Portal vein: Supplies blood to the liver and bile ducts.

Nerve Supply of the Bile Ducts:

1. Vagus nerve: Supplies nerves to the bile ducts.
2. Splanchnic nerves: Supplies nerves to the bile ducts.