CBD Stones Flashcards
What percentage of patients may pass common bile duct stones spontaneously without intervention?
~30%
What signs suggest choledhocholithiasis pre-operatively?
enlarged CBD on ultrasound, imaging of a CBD stone on US, biliary pancreatitis, elevated AST, ALT, LDH, and Bili
What are the published morbidity/mortality rates for ERCP
5-15% morbidity; 0-2% mortality rate
What structures should be visualized for an adequate intra-operative cholangiogram?
Common Bile Duct, Smooth taper into duodenum, Right and Left Hepatic Duct
Which drug helps to spasm/relax the sphincter of Oddi?
morphine/glucagon
What instruments are essential of common bile duct exploration is required?
choledochoscope, helical stone baskets, biliary balloon catheters, syringes, fluoroscopy
What are the most common complications of laparoscopic CBD exploration?
cystic duct stump leaks, pancreatitis, bile duct injury, bile duct stricture
What percentage of patients fail clearance of CBD by post-operative ERCP
5-10%
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
TRUE
At what locations are stay sutures placed for open/laparoscopic CBD exploration?
3 o’clock and 9 o’clock
Why should T-tubes not traverse the ampulla into the duodenum?
This can cause pancreatitis
What are options if an impacted stone is encountered?
Lithotripsy, duodenotomy and sphincteroplasty