CHOLEDOCHOLITHIASIS or COMMON BILE DUCT STONES
CHOLEDOCHOLITHIASIS or COMMON BILE DUCT STONES
- Stone inside the CBD and biliary tree.
TYPES-
- Primary stones-
- Formed in CBD and biliary tree.
- MC stone- brown stone
- Multiple
- More common in developing countries.
- Causes-
a) Defective pathophysiology of biliary tree-
- Stasis, biliary dyskinesia, sclerosing cholangitis
b) Congenital-
- Caroli’s disease, choledochal cyst
c) Infection and infestation-
- Clonorchiasis, ascariasis
d) Diabetes, malnutrition
2. Secondary stones-
- Most common type
- They are from GB (gallstones), pass through cystic duct to CBD
- Gallstones get impacted in supraduodenal portion of the CBD.
CLINICAL FEATURES–
- 50% asymptomatic
- Pain in right hypochondrium and epigastrium
- Jaundice (MC)
- Fever, chills, rigors
- Charcot’s traid
- Reynold’s pentad
- Triad includes- biliary colic, jaundice, charcot
INVESTIGATIONS-
- Increase ALP, GGT, 5’ nucleotidase
- ERCP- gold standard investigation
TREATMENT-
- ERCP + stone removal
- :arge stone- post operative enoscopic sphincterotomy and extraction
Exam Important
- Common bile duct stones will manifest: Jaundice,Itching,Clay coloured stools
TYPES-
- Primary stones-
- Formed in CBD and biliary tree.
- MC stone- brown stone
- Multiple
- More common in developing countries.
- Causes-
a) Defective pathophysiology of biliary tree-
- Stasis, biliary dyskinesia, sclerosing cholangitis
b) Congenital-
- Caroli’s disease, choledochal cyst
c) Infection and infestation-
- Clonorchiasis, ascariasis
d) Diabetes, malnutrition
2. Secondary stones-
- Most common type
- They are from GB (gallstones), pass through cystic duct to CBD
- Gallstones get impacted in supraduodenal portion of the CBD.
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