Choledocholitasis

Question 1

Define choledocholitiasis

Answer 1

common bile duct obstruction from a gallstone

Question 2

explain how a gallstone in the CBD results in s/s

Answer 2

gallstone in CBD ➔ inflammation proximal to the obstruction

results in obstructive jaundice ➔bilirubin cannot go down CBD and backs up to the liver

prolonged biliary colic episodes ➔ contracting against the obstructed CBD ➔ pain

Question 3

What is the hallmark s/s for choledocholitiasis?

Answer 3

obstructive jaundice

Question 4

What cx can come out of choledocholitiasis?

Answer 4

cholangitis ➔ can result in an infection
acute pancreatitis ➔ The gallstone can travel into the pancreatic duct

Question 5

What ix can also be used as a tx for choledocholitiasis?

Answer 5

ERCP - goot to visualize the the biliary tract but also either remove the stone or place a stent

Question 6

What would be your order of ix and reasoning for a suspected choledocholitasis?

Answer 6

1. pt coming in with pain ➔ RUQ U/S, may be able to see stones or dilated hepatic ducts
2. if we think it’s stones based on the U/S, then we can move straight into ERCP esp because it’s also therapeutic
3. if the U/S is inconclusive but the clinical picture is leading us to stones, tehn to an MRCP to better visualize

Question 7

How would you treat choledocholitasis?

Answer 7

1. ERCP, remove the stone
2. definitive, cholecystectomy bc there is a high risk of it happening again and the potential progression to cholangitis