choledocholithiasis Flashcards
What is the definition of choledocholithiasis?
-The presence of gallstones in the common bile duct
What are the clinical signs of choledocholithiasis?
- colicky RUQ or epigastric pain
- more severe and painful than cholelithiasis and lasts for 6 hours
- nausea and vomiting
- postprandially
What are the signs of extrahepatic cholestasis?
-jaundice
-pruritis
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What diagnostic tests do we do for choledocholithiasis?
- laboratory tests: Increased ALP, Increased GGT, Increased direct and total bilirubin
- Imaging: abdominal ultrasound, MRCP, ERCP, EUS
- Liver function tests-AST, ALT
What are the clinical features seen on the trans-abdominal ultrasound
-dilated common bile duct
When we do further confirmatory tests like ERCP,MRCP nad EUS?
If it is a high risk we do ERCP
- medium risk MRCP or EUS
- Low risk then just treat cholethiasis
What does ERCP stand for?
-endoscopic retrograde cholangiopancreatography
What is the treatment for choledocholithiasis?
- conservative treatment: spasmolytics, analgesia
2. definitive Treatment: use ERCP to remove the obstruction
How does ERCP work?
- both diagnostic and therapeutic
- the stone is extracted using a DORMIA basket
What are indications for using ERCP?
- choledocholithias
- acute cholangitis
- pancreatic gallstones
What are the complications of ERCP?
- haemorrhage
- cholangitis
- perforation
- post ERCP-pancreatitis(happens in 5%)
What procedure is needed to prevent choledocholithiasis?
-cholecystectomy: must be done 72 hours after ERCP
What are the complications of choledocholithiasis?
-gallstone ileus
gallstone pancreatitis
What are the clinical signs of gallstone ileus?
- pneumobilia which means the accumulation of gas in the biliary system
- nausea and vomiting and abdominal distension and pain
- perforation and fistula formation can occur that leads to the movement of the stones into the bowel lumen
What is the cause of choledocholithiasis?
- secondary cause is the most common cause: from cholithiasis which means the gallstones travel to common bile duct and obstruct which leads to spasm of biliary tract
- primary cause is the least cause: intraductal stone formation due to cystic fibrosis
What is the average size of a common bile duct?
<8-9mm
if it is bigger than 10mm it is abnormal
If we try to do a ERCP and it fails the first time what must we try and do?
-repeat the ERCP and stent in between to drain the bile
