CBD Stones Flashcards

1
Q

What percentage of patients may pass common bile duct stones spontaneously without intervention?

A

~30%

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2
Q

What signs suggest choledhocholithiasis pre-operatively?

A

enlarged CBD on ultrasound, imaging of a CBD stone on US, biliary pancreatitis, elevated AST, ALT, LDH, and Bili

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3
Q

What are the published morbidity/mortality rates for ERCP

A

5-15% morbidity; 0-2% mortality rate

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4
Q

What structures should be visualized for an adequate intra-operative cholangiogram?

A

Common Bile Duct, Smooth taper into duodenum, Right and Left Hepatic Duct

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5
Q

Which drug helps to spasm/relax the sphincter of Oddi?

A

morphine/glucagon

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6
Q

What instruments are essential of common bile duct exploration is required?

A

choledochoscope, helical stone baskets, biliary balloon catheters, syringes, fluoroscopy

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7
Q

What are the most common complications of laparoscopic CBD exploration?

A

cystic duct stump leaks, pancreatitis, bile duct injury, bile duct stricture

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8
Q

What percentage of patients fail clearance of CBD by post-operative ERCP

A

5-10%

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9
Q

T/F If the patient has a small CBD (<5mm) CBD exploration should be avoided as small stones will likely pass spontaneously OR the surgeon can proceed with postoperative ERCP

A

TRUE

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10
Q

At what locations are stay sutures placed for open/laparoscopic CBD exploration?

A

3 o’clock and 9 o’clock

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11
Q

Why should T-tubes not traverse the ampulla into the duodenum?

A

This can cause pancreatitis

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12
Q

What are options if an impacted stone is encountered?

A

Lithotripsy, duodenotomy and sphincteroplasty

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