Choledocholithiasis: Difference between revisions

Revision as of 04:19, 17 May 2017

Choledocholithiasis occurs when a stone is expelled out of the gallbladder and becomes impacted in the common bile duct
If infected, becomes Cholangitis

RUQ pain
- Radiation to the Right shoulder (phrenic nerve irritation)
- Early pain characterized as colicky (intermittent, comes and goes)
- Once impacted, is constant and severe
Nausea and Vomiting
Jaundice/scleral icterus
- Caused by build up of direct bilirubin in blood

Labs

Imaging

Ultrasound of RUQ
- Noninvasive and quick
- Common bile duct < 4 mm plus 1mm per decade after 40 yrs old
- While UTZ is highly sensitive and specific for acute cholecystitis, it lacks this in identifying cholelithiasis secondary to exam limitations (i.e. difficulty identifying the CBD)
ERCP - highly sensitive and specific, also therapeutic
MRCP - comparable to ERCP in Sn/Sp
HIDA Scan - not useful, as IDA (technetium 99m-labeled iminodiacetic acid) can still go into gallbladder

Pain relief
Fluid and electrolyte repletion
NPO
If any concern for concomitant acute cholecystitis, start antibiotics
- Always consider Cholangitis

Admission to medical services
- Consult to GI for spherincerotomy and stone removal vs General Surgery for operative management

Authors:

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 ==Background==
 *Choledocholithiasis occurs when a stone is expelled out of the gallbladder and becomes impacted in the common bile duct
+*If infected, becomes [[Cholangitis]]
-The biliary system includes the hepatic bile canaliculi, intrahepatic ducts, extrahepatic ducts, the gall bladder, the cystic duct, and the common bile duct. The liver produces bile, which is not only a byproduct of red blood cell breakdown, but also aids in digestion. The gallbladder stores bile until stimulated, upon which bile flows out the gallbladder, down the cystic duct into the common bile duct, and ultimately into the 1st portion of the duodenum.
-*Gallstones are classified as cholesterol stones and pigmented stones (black and brown), and are present in approx 20% of females and 8% of males in the United States
-*These stones cause the majority of all biliary tract problems, and depending on where the stone become impacted, specific problems occur.
 ==Clinical Features==