Choledocholithiasis


Choledocholithiasis

Description, Causes and Risk Factors:

Presence of stone in the common bile duct (any of the ducts conveying bile between the liver and the intestine, including hepatic, cystic, and common bile duct. A duct formed by the union of the hepatic and cystic ducts; it discharges at the duodenal papilla).

Choledocholithiasis

Choledocholithiasis, one of the most common medical conditions leading to surgical intervention, affects approximately 10 percent of the adult population in the United States. Choledocholithiasis develops in about 10%-20% of patients with gallbladder stones and the literature suggests that at least 3%-10% of patients undergoing cholecystectomy will have common bile duct (CBD) stones. CBD stones may be discovered preoperatively, intraoperatively or postoperatively.

In the Western world, most stones in the CBD arise from the passing of gallbladder stones into the CBD. Stones in the common duct occur in 10% to 15% of people who have gallbladder stones. Concomitant gallbladder stones and bile duct stones occur more frequently in elderly, Asian patients and in patients who have chronic bile duct.

Other Risk Factors May Include:

Nonmodi?able Factors:

    Increasing age.

  • Genetics, family history.

  • Female gender.

  • Ethnicity.

Modi?able Factors:

    Obesity.

  • Low-?ber, high-calorie diet.

  • Pregnancy and parity.

  • Prolonged fasting.

  • Oral contraceptives.

  • Low-level physical activities.

  • Rapid weight loss (> 1.5 kg/wk).

  • Hypertriglyceridemia/low high-density lipoprotein.

  • Metabolic syndrome.

  • Gallbladder stasis.

  • Speci?c diseases (cirrhosis, Crohn's disease with severe ileal involvement/resection).

Symptoms:

Symptoms may include:

    Fever.

  • Chills.

  • Nausea and vomiting.

  • Severe pain in the upper right abdomen.

  • Dark urine.

  • Rapid heart beat.

  • Abrupt drop in blood pressure.

Diagnosis:

Multiple modalities are available for assessing patients for choledocholithiasis including laboratory tests, ultrasound, computed tomography scans (CT), and magnetic resonance cholangiopancreatography (MRCP). Intraoperative cholangiography during cholecystectomy can be used routinely or selectively to diagnose choledocholithiasis.

Treatment:

The most common intervention for choledocholithiasis is ERCP (endoscopic retrograde choledochopancreatography). Other commonly used interventions include intraoperative bile duct exploration, either laparoscopic or open. Percutaneous, transhepatic stone removal other novel techniques of biliary clearance have been devised. The availability of equipment and skilled practitioners who are facile with these techniques varies among institutions. The timing of the intervention is often dictated by the clinical situation.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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