Choledocholithiasis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Choledocholithiasis is also known as bile duct stones or gallstones in the bile duct. Choledocholithiasis is the presence of a gallstone in the common bile duct. The gallstone is formed in the gall bladder, a pear-shaped organ where bile is stored before being released and transported through the bile duct. The bile ducts are a tube that carries bile from the liver and liver to the intestine, the bile, a greenish-brown alkaline fluid help to break down fats into fatty acids in the intestine. The stone formed in the gallstone can block the bile duct while transporting bile to the intestine, and 18% coexist with cholelithiasis patients.
Historical Perspective
Classification
Choledocholithiasis can be classified as Primary or Secondary
- Primary Choledocholithiasis is classified based on gallstones formed directly within the biliary and obstructing the common bile duct. Primary Choledocholithiasis is composed of brownstones and is less common compared to secondary choledocholithiasis. Primary choledocholithiasis often affect the biliary tree diffusely and have both intrahepatic and extrahepatic biliary stones. Intrahepatic stones may be complicated by recurrent pyogenic cholangitis.
- Secondary Choledocholithiasis is classified based on gallstones formed from the gall bladder and transported to block the common bile duct. This type of Choledocholithiasis is the most common type of Choledocholithiasis. The stone composition of secondary choledocholithiasis is similar to cholelithiasis with cholesterol stone as the most common type, and the cause is identical to the causes of gallstones. About 4.6% to 18.8% of patients undergoing cholecystectomy is found to have choledocholithiasis.
Pathophysiology
The Bile is made in the liver and stored in the gallbladder. Concentrated Bile from the gallbladder can lead to the formation of gall stone. The stone passes from the gall bladder to the cystic duct, then into the common bile duct (CBD), and block the CBD. Primary Choledocholithiasis has formed from stones within the bile duct that occur due to bile stasis in the CBD, forming an intraductal stone. The cause of bile duct stasis includes bile duct dilatation with increasing age. Less commonly, bile stasis can result from complications from Mirizzi Syndrome or hepatolithiasis (gallstone in the biliary duct of the liver). The obstructed flow of the bile duct leads to obstructive jaundice and possibly hepatitis. The stagnant Bile can lead to infection and inflammation of the bile duct, causing bactibilia and ascending cholangitis. If the blockage is at the common bile duct after the pancreatic duct, join the CBD, it can become inflamed, with autoactivation of pancreatic enzymes leading to gallstone pancreatitis.
Causes
Choledocholithiasis causes include primary and secondary causes.
- Primary causes are rare, and they are usually brown pigment stones formed in the bile duct. Recurrent Pyogenic Cholangitis (RCC), also known as Oriental Cholangiohepatitis hepatolithiasis, is an intrahepatic brown pigment stone exclusive to individuals who live or lived in southeast Asia. It is caused by a bacterial in the bile duct, undernutrition, and parasitic infection (e.g., Clonorchis Sinensis, Opisthorchis viverrini) leading to chronic bacterial cholangitis with primary hepatolithiasis.
- Secondary causes occur in greater than 85% of people in a developed country, and about 10% presents symptomatically after Cholecystectomy. Secondary causes are caused by stones from the gallbladder, with cholesterol stones being the most common.
Other causes include residual stones that develop in the ducts greater than # years after surgery.
Differentiating Choledocholithiasis from other Diseases
- Cholecystitis
- Perforated peptic ulcer
- Acute peptic ulcer exacerbation
- Amoebic liver abscess
- Acute amoebic liver colitis
- Acute pancreatitis
- Acute intestinal obstruction
- Renal colic
- Acute retrocolic appendicitis
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other diagnostic Studies
Treatment
Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies