Jaundice from Gallstones: When the Bile Duct Is Blocked
- What is jaundice? (Yellow skin/eyes from bilirubin)
- How gallstones cause obstructive jaundice
- Symptoms – yellow skin, dark urine, pale stools, itching, pain
- Diagnosis – blood tests, ultrasound, MRCP, ERCP
- Treatment – ERCP with stone extraction, cholecystectomy
- Complications – cholangitis, liver damage, pancreatitis
- Interactive FAQ – 9 common questions
What is jaundice? (Yellow skin/eyes from bilirubin)
Jaundice is the yellow discolouration of the skin, sclerae (whites of the eyes), and mucous membranes caused by elevated levels of bilirubin in the blood. Bilirubin is a yellow pigment produced when red blood cells break down. Normally, the liver processes bilirubin and excretes it into bile, which flows through the bile duct into the intestine. When a gallstone obstructs the common bile duct, bilirubin cannot drain properly, leading to accumulation in the blood and tissues. Jaundice is not a disease itself but a sign of an underlying problem – in this case, bile duct obstruction.
How gallstones cause obstructive jaundice
Obstructive jaundice from gallstones occurs when a stone migrates from the gallbladder into the common bile duct (choledocholithiasis) and becomes lodged, blocking bile flow. Less commonly, a large stone in the cystic duct can compress the common bile duct from the outside (Mirizzi syndrome). The obstruction can be partial or complete. Complete obstruction leads to rapid jaundice and risk of cholangitis. The most common site of impaction is the distal common bile duct near the ampulla of Vater.
Symptoms – yellow skin, dark urine, pale stools, itching, pain
The classic symptoms of obstructive jaundice from gallstones include:
- Yellow discoloration of the skin and eyes (jaundice).
- Dark urine (tea‑coloured or cola‑coloured) – due to bilirubin excreted by the kidneys.
- Pale, clay‑coloured stools – absence of bilirubin in the intestine.
- Generalised pruritus (itching) – caused by bile salts deposited in the skin.
- Right upper quadrant or epigastric pain – may be colicky or constant.
- Nausea and vomiting.
- Fever (if cholangitis develops).
Diagnosis – blood tests, ultrasound, MRCP, ERCP
Diagnosis of obstructive jaundice involves confirming bile duct obstruction and identifying the cause:
- Liver function tests (LFTs): Elevated alkaline phosphatase (ALP), gamma‑glutamyl transferase (GGT), and direct (conjugated) bilirubin. ALT/AST may be mildly elevated.
- Complete blood count (CBC): Elevated white blood cells suggest cholangitis.
- Abdominal ultrasound: First‑line imaging. May show dilated intrahepatic and extrahepatic bile ducts (>6‑8mm) and sometimes the obstructing stone.
- MRCP (magnetic resonance cholangiopancreatography): Non‑invasive, highly sensitive for bile duct stones and level of obstruction. Preferred for diagnosis.
- Endoscopic ultrasound (EUS): Very sensitive for small stones; can be followed by ERCP.
- ERCP (endoscopic retrograde cholangiopancreatography): Both diagnostic and therapeutic. Confirms the stone and allows removal.
Treatment – ERCP with stone extraction, cholecystectomy
Treatment aims to relieve the obstruction and prevent recurrence:
- ERCP with sphincterotomy and stone extraction: The standard of care. A balloon or basket is used to remove the stone from the common bile duct. Success rate >90%.
- Antibiotics: If cholangitis is suspected, intravenous broad‑spectrum antibiotics are started immediately.
- Cholecystectomy: After ERCP, the gallbladder must be removed (unless the patient is at high surgical risk). Without cholecystectomy, 30‑50% of patients will develop recurrent CBD stones within 5 years.
- Percutaneous transhepatic biliary drainage (PTBD): If ERCP fails or is not possible (e.g., altered anatomy), a drain is placed through the liver to relieve obstruction.
Complications – cholangitis, liver damage, pancreatitis
Untreated or prolonged obstructive jaundice from gallstones can lead to:
- Ascending cholangitis (bile duct infection) – life‑threatening sepsis.
- Secondary biliary cirrhosis – chronic obstruction leads to liver fibrosis and cirrhosis.
- Gallstone pancreatitis – if the stone impacts the ampulla.
- Coagulopathy – vitamin K malabsorption (fat‑soluble vitamins) leading to bleeding risk.
- Renal impairment (hepatorenal syndrome).
Interactive FAQ – Jaundice from gallstones
Jaundice usually appears within 24‑48 hours of complete obstruction. Partial obstruction may cause fluctuating jaundice over days to weeks.
If the stone passes spontaneously, jaundice may resolve. However, the risk of complications (cholangitis, pancreatitis) is high, so active removal is recommended.
Obstructive jaundice is due to bile duct blockage (stones, tumours). Hepatocellular jaundice is due to liver disease (hepatitis, cirrhosis). LFTs help differentiate: obstructive shows elevated ALP/GGT; hepatocellular shows elevated ALT/AST.
Yes – ERCP is the standard of care for CBD stones causing jaundice. It both confirms the diagnosis and removes the stone.
Bilirubin levels start to fall within 24‑48 hours after successful stone removal. Jaundice typically resolves in 1‑2 weeks.
Yes – some patients with CBD stones have painless jaundice. This is more common in elderly or diabetic patients.
High – up to 30‑50% of patients with persistent CBD stones develop cholangitis within weeks. Cholangitis can be fatal.
CT can show bile duct dilation and sometimes calcified stones, but MRCP or EUS are more sensitive for non‑calcified stones.
Yes – unless you are at very high surgical risk. Without cholecystectomy, the risk of recurrent CBD stones and jaundice is high.
Disclaimer: This information is for educational purposes. If you have jaundice with abdominal pain or fever, seek immediate medical attention at Vivekananda Hospital.