Choledocholithiasis is a condition that occurs due to stone in the common bile duct. Gall stones generally develop in the gall bladder. Gallbladder is small sac located below liver. Its main function is to collect and store bile, a thick fluid that is needed for digestion of fat in the intestine.
Bile passes through a tube joined between gallbladder and first part of small intestine.This tube is called common bile duct. Usually the stone develops and stays in the gallbladder. But in 15 to 20 percent of patients the stones moves from the gallbladder and lodges in the common bile duct causing obstruction of the bile flow.
Causes And Risk Factors Of Choledocholithiasis
Gallstones are generally of two varieties, cholesterol gallstones and pigmentary gallstones. When the bile contains too much of cholesterol, excessive bilirubin and insufficient bile salts, it can develop into cholesterol stones.The exact reason for development of pigment stones is not clear. However, it is seen in people with cirrhosis of liver, biliary tract infection and certain disorders in which the liver start making excess of bilirubin.
- People with history of gallstone formation may have greater chance of developing bile duct stones.
- Obese people especially women are susceptible to develop choledocholithiasis.
- People eating excessive fatty items and low fiber content in their diet.
- Pregnant women.
- Prolonged starvation and fasting.
- Rapid loss of weight.
- Sedentary people.
- People over the age of 40 are more likely to suffer from choledocholithiasis.
- Family history.
Signs And Symptoms Of Choledocholithiasis
Since the disease choledocholithiasis occurs in elderly age group patients the symptoms are often vague. Some patients remain asymptomatic for long duration of time until the stone block the common bile duct. Symptoms occur when the gallstone obstructs the bile flow.
Here are the most prominent symptoms of choledocholithiasis. If the stone gets blocked there is more likelihood of infection in the biliary tree. This may spread quickly into the liver and other organs which may be dangerous.
- Severe pain in right and upper middle quadrant of the abdomen.
- Vomiting and nausea.
- Pain may radiate to back and right shoulder.
- Loss of appetite
- Clay colored stool
Diagnosis And Treatment Of Choledocholithiasis
When the physician suspects choledocholithiasis, he may recommend the patient for following tests:
- Ultrasound of abdomen: In this procedure sound waves are passed through the abdomen with the help of a probe. The sound waves produce images which may indicate stone.
- CT scan of abdomen.
- ERCP: Endoscopic retrograde cholangiography is the most important test to determine stone in the common bile duct.
- Blood test for bilirubin, bile salts. They are raised if there is obstruction from the stone.
- Test for pancreatic enzymes.
The main aim of treatment is to remove the stone from the bile duct. There are several procedures that may be used to remove the stone from the common bile duct.
- Biliary endoscopic sphincterectomy: In this procedure a small device is inserted into the bile duct. The end of the device is like a basket. It catches the stone and extracts the stone.
- If the stone is not removable with BES, than the other option used by doctors is lithotripsy. In this procedure, the stone is made into tiny fragments. The stone can thus pass slowly into the intestine. In some cases the stones can be captured with the help of BES.
- If there are plenty of stones in the gallbladder the best way is to remove the gallbladder surgically. During the surgery, the doctor also checks if there are stones in the common bile duct.
- Biliary stents: This stent help the passage of stone once it is placed in the biliary tract. It also prevents further episodes of choledocholithiasis.