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Suggest Treatment For Prominent Common Bile Duct?
Question: Hello, I am a 49 y/I male with a history of 'fatty liver' not caused by alcohol. I do not look overweight but I carry all excess pounds around my abdominal area, my BMI is around 30. I recently had an US and am concerned about it stating that the Common Bile Duct was 'prominent' (9mm). No other finding present. Blood work also done, all within normal limits (alt=53 Ast=29 bilirubin also within normal limits)
I am not jaundiced and other than a very vague/dull pain on occasion on my right side (which very well could be me just being overly sensitive) I feel fine. 1. Does a "prominent' common bile duct mean that there is an obstruction? Does this sound serious?
I am not jaundiced and other than a very vague/dull pain on occasion on my right side (which very well could be me just being overly sensitive) I feel fine. 1. Does a "prominent' common bile duct mean that there is an obstruction? Does this sound serious?
Brief Answer:
Causes of prominent CBD discussed below
Detailed Answer:
Hi XXXXXXX
Thanks for writing in to us.
I have read through your query in detail.
The common bile duct is a tubular passage which transports the bile from the liver to the duodenum. The acceptable normal limit of CBD at you age is 6 mm in diameter however a prominent CBD can measure 9 mm even in normal subjects.
The causes of a prominent CBD in disease are
1. Stones in the biliary pathway including gall bladder and cystic duct. Stones in pancreatic duct can also show a prominent CBD.
2. Due to any constriction ( benign most common) in the biliary pathways within the liver (intrahepatic) or external to the liver (extrahepatic) and diseases in the liver, gall bladder or pancreas.
As all tests are normal, you may be having your CBD being prominent can be a variant. Should there be any doubt of disease which was not well seen on ultrasound, you can discuss the need for a CT scan or MRI scan of your abdomen as you are clinically still having pain on your right side.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Causes of prominent CBD discussed below
Detailed Answer:
Hi XXXXXXX
Thanks for writing in to us.
I have read through your query in detail.
The common bile duct is a tubular passage which transports the bile from the liver to the duodenum. The acceptable normal limit of CBD at you age is 6 mm in diameter however a prominent CBD can measure 9 mm even in normal subjects.
The causes of a prominent CBD in disease are
1. Stones in the biliary pathway including gall bladder and cystic duct. Stones in pancreatic duct can also show a prominent CBD.
2. Due to any constriction ( benign most common) in the biliary pathways within the liver (intrahepatic) or external to the liver (extrahepatic) and diseases in the liver, gall bladder or pancreas.
As all tests are normal, you may be having your CBD being prominent can be a variant. Should there be any doubt of disease which was not well seen on ultrasound, you can discuss the need for a CT scan or MRI scan of your abdomen as you are clinically still having pain on your right side.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Yogesh D
Thanks for your reply.
So if I understand you correctly:
- a 'prominent' common bile duct is not a reference to an 'obstruction' of the duct
- the 9mm measurement could be normal
-
Is a prominent common bile duct the same as a dilated common bile duct?
Given my long history with 'fatty liver' could that explain it? I've been tested for hep a/b/c, all negative. Have been taking blood tests once every 2 years since they discovered this (1999) and with the exception of slight elevations in alt/ast (alt always being higher) no other liver function test has been abnormal.
-
Thanks again.
So if I understand you correctly:
- a 'prominent' common bile duct is not a reference to an 'obstruction' of the duct
- the 9mm measurement could be normal
-
Is a prominent common bile duct the same as a dilated common bile duct?
Given my long history with 'fatty liver' could that explain it? I've been tested for hep a/b/c, all negative. Have been taking blood tests once every 2 years since they discovered this (1999) and with the exception of slight elevations in alt/ast (alt always being higher) no other liver function test has been abnormal.
-
Thanks again.
Brief Answer:
40% having prominent CBD are completely normal
Detailed Answer:
Hi XXXXXXX
Thanks for writing back with an update.
A prominent common bile duct need not necessarily refer to a biliary obstruction and can be a normal finding in the absence of other probable disease conditions involving liver, gall bladder and pancreas. I suppose other conditions have been ruled out in you and therefore finding of an isolated prominent common bile duct can be more of a normal observation.
Dilatation refers to a higher degree of prominence however some may give a 9 mm CBD as dilated. The measurement (9 mm in you) is more important when talking of prominent or dilated CBD.
As you have non alcoholic fatty liver, getting the tests done every two years is recommended.
I have reviewed a medical research on patients who have prominent CBD in the absence of any jaundice or specific biliary symptoms and find that 40 % of such patients are completely normal and findings may be seen on ERCP (investigation to study the CBD) in the rest.
You may see the medical literature at following link
http://www.ncbi.nlm.nih.gov/pubmed/0000
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
40% having prominent CBD are completely normal
Detailed Answer:
Hi XXXXXXX
Thanks for writing back with an update.
A prominent common bile duct need not necessarily refer to a biliary obstruction and can be a normal finding in the absence of other probable disease conditions involving liver, gall bladder and pancreas. I suppose other conditions have been ruled out in you and therefore finding of an isolated prominent common bile duct can be more of a normal observation.
Dilatation refers to a higher degree of prominence however some may give a 9 mm CBD as dilated. The measurement (9 mm in you) is more important when talking of prominent or dilated CBD.
As you have non alcoholic fatty liver, getting the tests done every two years is recommended.
I have reviewed a medical research on patients who have prominent CBD in the absence of any jaundice or specific biliary symptoms and find that 40 % of such patients are completely normal and findings may be seen on ERCP (investigation to study the CBD) in the rest.
You may see the medical literature at following link
http://www.ncbi.nlm.nih.gov/pubmed/0000
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Above answer was peer-reviewed by :
Dr. Yogesh D
So given my history of 'Fatty Liver' is it reasonable to assume that
1. Fatty Liver is affecting the gallbladder
2. That the slightly 'prominent' common bile duct
may be due to inflammation casused by Fatty Liver?
1. Fatty Liver is affecting the gallbladder
2. That the slightly 'prominent' common bile duct
may be due to inflammation casused by Fatty Liver?
Brief Answer:
Not related to history of fatty liver
Detailed Answer:
Hi XXXXXXX
Thanks for writing back with an update.
In my opinion there is no connection of your having a fatty liver and the prominent CBD.
So the answers to the questions are:
1. Fatty liver is not affecting the gall bladder.
2. The slightly prominent common bile duct is not due to inflammation caused by fatty liver.
You blood work for liver is normal so I would not even say that you are having any inflammation of the liver.
At the moment there is nothing to worry and you may wait until you meet your own doctor. You may however try and have a balanced diet and also keep a record of the dull pain like sensations which may be discussed with your doctor.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
Not related to history of fatty liver
Detailed Answer:
Hi XXXXXXX
Thanks for writing back with an update.
In my opinion there is no connection of your having a fatty liver and the prominent CBD.
So the answers to the questions are:
1. Fatty liver is not affecting the gall bladder.
2. The slightly prominent common bile duct is not due to inflammation caused by fatty liver.
You blood work for liver is normal so I would not even say that you are having any inflammation of the liver.
At the moment there is nothing to worry and you may wait until you meet your own doctor. You may however try and have a balanced diet and also keep a record of the dull pain like sensations which may be discussed with your doctor.
Hope your query is answered.
Do write back if you have any doubts.
Regards,
Dr.Vivek
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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