Choledocholithiasis

The condition where gall stones are present in the common bile duct is called choledocholithiasis. The gall bladder is an organ which is present in the upper right quadrant of the abdomen below the liver. Gallstones are formed and present in the gall bladder. The bile duct is a tube that is responsible for carrying bile from the gall bladder to the intestine. The stones pass through the common bile duct without any obstruction. They are made up of calcium or bile pigments and cholesterol salts. Gall stones with no symptoms are called silent stones.

Courtesy of ADAM

Courtesy of ADAM

Causes

There are predominantly two main types of gall stones cholesterol stones and pigment stones. Cholesterol stones are yellow in color and constitute about 80% of the gall stones. Pigment stones are made of bilirubin and are small and dark.

  • Too much bile secretion: When there is an imbalance in material that make up bile and there is too much cholesterol in the bile
  • Gall bladder does not empty: If the gall bladder lacks the ability to empty completely, it can result in gall stones
  • Cirrhosis: Individuals with medical conditions such as cirrhosis of the liver where the scar tissue replaces the healthier one
  • Blood diseases: Sickle cell anemia
  • Heredity: In individuals that are genetically disposed to carry the disease as it is present in the family
  • Obesity: Due to high levels of cholesterol, the gall bladder does not empty completely
  • Estrogen: Reduces gall bladder motility and increases cholesterol
  • Gender: Gall stones are common in women
  • Age: Increased risk of happening in older people
  • Diabetes: High levels of triglycerides
  • Rapid weight loss: quick weight loss induces cholesterol production and leads to gall stones.

Symptoms

  • Constant and cramping pain in upper right abdomen for 30 minutes either sharp or dull
  • Jaundice
  • Loss appetite
  • Fever
  • Chills
  • Clay-colored stool
  • Nausea and vomiting

Diagnosis

Liver function blood test: This blood test, if indicates an elevation in bilirubin, serum transaminases and also others such as ampula of vater., suggests liver derangement.
ERCP:Endoscopic retrograde cholangiography views the narrowed area of the bile duct and extracts any stones present in it.
Abdominal CT scan: x-rays are used to create cross-sectional pictures of the belly.
Abdominal ultrasound: It is a type of imaging that examines the spleen, gall bladder, liver, pancreas and kidneys in the abdomen.
Endoscopic ultrasound: EUS is also called echo-endoscopy where a probe is inserted into the organ and an ultrasound obtains images of the organ in the abdomen.
Magnetic resonance cholangiopancreatography: MRCP is a technique which uses non-invasive resonance imaging to view the biliary ducts and if gall stones are present in the gall bladder.
Percutaneous transhepatic cholangiogram: PTCA provides x-ray of the bile ducts.
Other blood tests :These include bilirubin, CBC and pancreatic enzymes testing.