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    Choledocholithiasis

    Gallstone in the bile duct; Bile duct stone

    Choledocholithiasis is the presence of at least one gallstone in the common bile duct. The stone may be made up of bile pigments or calcium and cholesterol salts.

    Causes

    About 15% of people with gallstones will develop stones in the common bile duct, the small tube that carries bile from the gallbladder to the intestine.

    Risk factors include a history of gallstones. However, choledocholithiasis can occur in people who have had their gallbladder removed.

    Symptoms

    Symptoms usually do not occur unless the stone blocks the common bile duct. Symptoms that may occur include:

    • Abdominal pain in the right upper or middle upper abdomen that may:
      • Be steady
      • Be sharp, cramping, or dull
      • Spread to the back or below the right shoulder blade
    • Fever
    • Loss of appetite
    • Jaundice (yellowing of skin and whites of eyes)
    • Nausea andvomiting

    Exams and Tests

    Tests that show the location of stones in the bile duct include the following:

    • Abdominal CT scan
    • Abdominal ultrasound
    • Endoscopic retrograde cholangiography (ERCP)
    • Endoscopic ultrasound
    • Magnetic resonance cholangiopancreatography (MRCP)
    • Percutaneous transhepatic cholangiogram (PTCA)

    Your doctor may order the following blood tests:

    • Bilirubin
    • Complete blood count (CBC)
    • Liver function tests
    • Pancreatic enzymes

    Treatment

    The goal of treatment is to relieve the blockage.

    Treatment may involve:

    • Surgery to remove the gallbladder and stones
    • ERCP and a procedure called a sphincterotomy, which makes a surgical cut into the muscle in the common bile duct to allow stones to pass or be removed

    Outlook (Prognosis)

    Blockage and infection caused by stones in the biliary tract can be life threatening. However, with prompt diagnosis and treatment, the outcome is usually very good.

    Possible Complications

    • Biliary cirrhosis
    • Cholangitis
    • Pancreatitis

    When to Contact a Medical Professional

    Call for an appointment with your health care provider if:

    • You develop abdominal pain, with or without fever, and there is no known cause
    • You develop jaundice
    • You have other symptoms of choledocholithiasis

    References

    Chari RS, Shah SA. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap. 54.

    Glasgow RE, Mulvihill SJ. Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 66.

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    • Kidney cyst with gallsto...

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    • Choledocholithiasis

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    • Gallbladder

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    • Gallbladder

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    • Bile pathway

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      • Digestive system

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      • Kidney cyst with gallsto...

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      • Choledocholithiasis

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      • Gallbladder

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      • Gallbladder

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      A Closer Look

      Review Date: 8/11/2011

      Reviewed By: Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

      The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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