Common bile duct stones

Common Bile Duct Stones

Common bile duct stones, also known as choledocholithiasis, are stones that form in the common bile duct, which is the duct that carries bile from the liver and gallbladder to the duodenum. These stones can cause significant health issues, including pain, infection, and jaundice.

Pathophysiology

Common bile duct stones can originate in the gallbladder and migrate into the bile duct, or they can form directly within the duct itself. The stones are typically composed of cholesterol or bilirubin, and their formation is influenced by factors such as bile stasis, infection, and changes in bile composition.

Clinical Presentation

Patients with common bile duct stones may present with a variety of symptoms, including:

• Abdominal pain, particularly in the right upper quadrant
• Jaundice, due to obstruction of bile flow
• Fever and chills, if infection such as cholangitis is present
• Nausea and vomiting

Diagnosis

The diagnosis of common bile duct stones can be made using several imaging techniques:

• Ultrasound: Often the first imaging test performed, but may not always detect stones in the bile duct.
• Magnetic Resonance Cholangiopancreatography (MRCP): A non-invasive imaging technique that provides detailed images of the bile ducts.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): A procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions of the bile and pancreatic ducts.

Treatment

The treatment of common bile duct stones often involves:

• Endoscopic Sphincterotomy and stone extraction via ERCP, which is the most common method.
• Surgical removal of the stones, which may be necessary if ERCP is unsuccessful.
• Cholecystectomy, or removal of the gallbladder, to prevent recurrence of stones.

Complications

If left untreated, common bile duct stones can lead to serious complications such as:

• Acute pancreatitis
• Cholangitis, an infection of the bile duct
• Biliary cirrhosis, due to prolonged obstruction

Prevention

Preventive measures may include dietary modifications, such as reducing fat intake, and in some cases, medications to dissolve cholesterol stones.

Also see

• Gallstones
• Cholecystitis
• Pancreatitis
• Biliary tract

Classification
External resources