Bile duct stones

Question 1

What is another name for bile duct stones?

Answer 1

Choledocholithiasis

Question 2

What is the epidemiology of bile duct stones?

Answer 2

Incidence of choledocholithiasis in patients with cholelithiasis increases with age.

More common in women, pregnant patients, older patients and those with high lipid levels.

Question 3

What is the pathophysiology of bile duct stones?

Answer 3

· The gallstone blocks the CBD and bile can’t flow past it, instead backing up into the liver.
· This leads to obstructive jaundice and possibly hepatitis.

· The stagnant bile can lead to ascending cholangitis.

Question 4

What is the prognosis for bile duct stones?

Answer 4

Not associated with increased mortality or morbidity. But its complications can be.

Question 5

What is the aetiology of bile duct stones?

Answer 5

· Gallstones can pass from the gallbladder into the cystic duct, and then the CBD spontaneously.
· Stones that are too large to pass through the ampulla of Vater remain in the distal CBD.
· Most commonly cholesterol stones.
· Mirizzi syndrome can cause it too.

Question 6

What risk factors are associated with bile duct stones?

Answer 6

· Bile stasis - CF. 
· Pregnancy. 
· >40 years old. 
· Female
· Obesity. 
· OCP.
· Sickle cell disease. 
· Cirrhosis. 
· Hyperlipidaemia.

Question 7

What signs and symptoms accompany bile duct stones?

Answer 7

· RUQ/epigastric pain. 
· Jaundice. 
· Pruritis. 
· Nausea and vomiting. 
· Pale stool or dark urine. 
· Gallstone pancreatitis (if the stone stops enzymes flowing from the pancreas to the intestine).

Question 8

What investigations help diagnose bile duct stones?

Answer 8

· FBC.
· LFTs.
· U&Es. 
· Coagulation profile. 
· USS.
· MRCP.

Question 9

Suggest some differential diagnoses.

Answer 9

· Bile duct/pancreatitis/gall bladder cancer.
· Bile duct stricture.
· Pancreatitis.
· Cholecystitis.

Question 10

What are the treatment options for bile duct stones?

Answer 10

· ERCP/MRCP.

· Laparoscopic cholecystectomy with bile duct exploration.

Question 11

What complications can occur with bile duct stones?

Answer 11

· Pancreatitis.
· Wound infection.
· Cholangitis.