Biliary Obstruction

Clinical Presentation: Symptoms of Biliary Obstruction

• Jaundice: Yellowing of skin and sclera due to elevated bilirubin
  
• Dark Urine: Bilirubin excreted in urine, often amber or tea-colored
  
• Pale or Clay-Colored Stools: From lack of bile pigments
  
• Pruritus (Itching): Bile salt accumulation in skin
  
• Right Upper Quadrant Pain: Sharp, constant, may radiate to back/shoulder
  
• Nausea & Vomiting: Especially after high-fat meals
  
• Unintended Weight Loss & Fever: Suggest malignancy or infection

   

If untreated, obstruction can progress to ascending cholangitis, biliary cirrhosis, and secondary pancreatic insufficiency.

Diagnostic Evaluation and Biomarkers

1. Laboratory Tests:
   
   • Total Bilirubin & Direct Bilirubin
     
   • Alk Phos & GGT
     
   • AST, ALT, Albumin, Prothrombin Time
     
2. Imaging:
   
   • Ultrasound: Detects duct dilation, gallstones
     
   • CT/MRCP: Visualizes masses and duct anatomy
     
   • HIDA Scan: Assesses gallbladder ejection fraction
     
3. Procedural Diagnostics:
   
   • ERCP: Diagnostic and therapeutic (stent placement, stone removal)
     
   • PTC: Alternative when ERCP isn’t possible
     
   • Liver Biopsy: In select cases of parenchymal disease

      

Functional evaluation also considers fat-soluble vitamin status and systemic inflammation (hs-CRP, ferritin).

Underlying Causes of Biliary Obstruction

1. Gallstones: Often originate in the gallbladder and migrate into the common duct
   
2. Tumors: Cholangiocarcinoma, pancreatic head carcinoma, liver metastases
   
3. Strictures: From surgery, chronic inflammation, or autoimmune conditions
   
4. Chronic Pancreatitis: Scarring/compression of the duct
   
5. Parasitic Infections: Liver flukes (Clonorchis) or Ascaris in endemic regions

    

Drug Effects and Interfering Factors

• Anabolic Steroids & Oral Contraceptives: Impair bile flow, raise bilirubin
  
• Certain Antibiotics: Erythromycin, ampicillin, sulfonamides can cause biliary insufficiency/stasis
  
• Chemotherapy & Psychotropics: May elevate alk phos and GGT
  
• Interferences: Hemolysis, fasting state, alcohol intake

   

Associated Conditions and Long-Term Risks

• Cholangitis: Bacterial infection of bile ducts; may progress to sepsis
  
• Biliary Cirrhosis: Long-standing obstruction leads to fibrosis → biliary cirrhosis
  
• Pancreatitis: Impaired pancreatic drainage → pancreatic insufficiency
• Vitamin Deficiencies & Coagulopathy: Malabsorption of A, D, E, and K → vitamin status

Functional Medicine Approach at Intercoastal Health

1. Root-Cause Resolution: ERCP/surgery referral, specialist collaboration
   
2. Nutritional Optimization: Anti-inflammatory whole foods; correct A, D, E, K levels; MCTs
   
3. Bile Flow Support: Ox bile, phosphatidylcholine, digestive bitters, botanicals
   
4. Detoxification Support: NAC, glutathione, magnesium, B-complex; post-obstruction detox
5. Monitoring & Prevention: Regular LFTs, nutrient panels; lifestyle coaching for gallstone prevention

Further Reading

• Chapman MH, et al. “Management of Acute Biliary Obstruction: ERCP versus PTC.” J Hepatobiliary Pancreat Sci. 2017;24(2):66–76. https://pubmed.ncbi.nlm.nih.gov/27625444/
  
• Navaneethan U, et al. “Malignant Biliary Strictures: Emerging Diagnostic and Therapeutic Approaches.” Nat Rev Gastroenterol Hepatol. 2019;16(6):333–348. https://pubmed.ncbi.nlm.nih.gov/30953618/
  
• Pasarín M, et al. “Pathogenesis of Cholestatic Liver Injury.” J Hepatol. 2019;70(2):338–350. https://pubmed.ncbi.nlm.nih.gov/30399486/
  
• Loo N, et al. “Splanchnic Circulation in Cholestatic Liver Disease.” Liver Int. 2018;38(9):1646–1657. https://pubmed.ncbi.nlm.nih.gov/29669322/
• Lee SP, et al. “Role of Bile Acids in Regenerative Therapy for Cholestatic Liver Disease.” Hepatology. 2020;72(4):1542–1553. https://pubmed.ncbi.nlm.nih.gov/32445467/

Conclusion

In conclusion, a comprehensive evaluation by a functional medicine nurse practitioner in Florida facilitates identification of cellular-level and molecular imbalances driving hepatobiliary dysfunction. By integrating evidence-based therapies with IV therapy and Regenerative Medicine services—where digestive and systemic health intersect—we offer patients a preventive framework to rebuild resilience and optimize wellness. Call (904) 799-2531 or schedule online to request your personalized biliary health assessment.