Obstructive biliary tract disease encompasses a spectrum of conditions that impede the normal flow of bile from the liver to the duodenum, resulting in cholestasis, jaundice, and potential hepatic dysfunction. Etiologies include both benign and malignant causes, such as cholelithiasis, biliary strictures, cholangiocarcinoma, and pancreatic neoplasms. The pathophysiology involves mechanical blockage or compression of the biliary ducts, leading to elevated conjugated bilirubin, bile duct dilatation, and hepatocellular injury. Clinical presentation varies from asymptomatic biochemical abnormalities to overt symptoms, including jaundice, pruritus, right upper quadrant pain, and fever. Diagnostic evaluation begins with ultrasonography, which is highly sensitive for detecting ductal dilatation and gallstones. Advanced imaging modalities, such as magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP), provide detailed anatomical visualization and therapeutic access. MRCP offers superior sensitivity and specificity for both benign and malignant lesions, particularly in distal common bile duct obstructions. Management depends on the underlying cause and severity. ERCP remains the cornerstone for therapeutic intervention, enabling stone extraction, stent placement, and biopsy. Surgical options, including cholecystectomy and biliary bypass, are reserved for refractory or complex cases. Malignant obstructions may require palliative stenting and oncologic therapies. Early diagnosis and tailored intervention are critical to prevent complications such as biliary cirrhosis, cholangitis, and hepatic failure.