Choledocholithiasis Flashcards
What is the common bile duct?
this is the main pathway for bile from the liver to the duodenum
it joins with the pancreatic duct at the ampulla of water and bile exits through the sphincter of odd to enter into the duodenum
what is choledocolithiasis
gallstones in the common bile duct
what is secondary choledocholithiasis
this is the more common form of choledocolithiasis that occurs when stones exit the gallbladder through the cystic duct into the common bile duct
typically cholesterol or black pigment stones
what is primary choledocholithiasis
this is a more rare form of choledocolithiasis that results from an infection of the biliary tree and leads to intraductal brown pigment stones
does a previous cholecystectomy rule out the possibility of choledocolithiasis?
no, the stone may be retained in the common bile duct or develop inside of it
if someone has choledocolithiasis without symptoms do they require management?
no
symptoms of choledocholithiasis
RUQ or epigastric pain that does not subside, N/V, obstructive painful jaundice, dark urine, pale stool, pruritus
labs in choledocolithiasis
cholestatic pattern with increased conjugated + total bilirubin and alkaline phosphatase + GGT, increased lipase and amylase, increased WBC
early in the disease of choledocolithiasis what is elevated?
ASTs and ALTs can be elevated
complications of choledocolithiasis
gallstone pancreatitis (amylase and lipase), cholangitis (increased WBC)
imaging for choledocolithiasis
RUQ ultrasound to rule out
MCRP- shows dilated billiary anatomy or stone
Endoscopic ultrasound
ECRP (gold standard)
steps of ERCP
take an endoscopy to the duodenum and access the ampulla of water through major papilla
use basket or balloon to remove stone
*spincterotomy may also be preformed
what is post cholecystectomy syndrome
recurrent biliary pain following a cholecystectomy with dyspepsia
can be caused by many things: retained stone, sphincter of odd dysfunction, pancreatitis
causes of EARLY post cholecystectomy syndrome
biliary injury, retained cystic duct, CBD stones
causes of LATE PCS
recurrent CBD stones, bile duct stricture, inflamed cystic duct or gallbladder remnant, papillary stenosis, biliary dyskinesia
