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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 1 in 7 people with gallstones will develop stones in the common bile duct. This is 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

 

Often, there are no symptoms unless the stone blocks the common bile duct. Symptoms may include:

  • Pain in the right upper or middle upper abdomen for at least 30 minutes. The pain may be constant or cramping. It can feel sharp or dull.
  • Fever
  • Yellowing of skin and whites of the eyes (jaundice)
  • Loss of appetite
  • Nausea and vomiting
  • Clay-colored stools

 

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 health care provider 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. Most of the time, the outcome is good if the problem is detected and treated early.

 

Possible Complications

 

Complications may include:

  • Biliary cirrhosis
  • Cholangitis
  • Pancreatitis

 

When to Contact a Medical Professional

 

Call your 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

Fogel EL, Sherman S. Diseases of the gallbladder and bile ducts. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 155.

Jackson PG, Evans SRT. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. St. Louis, MO: WB Saunders; 2012:chap 55.

 
  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Kidney cyst with gallstones, CT scan

    Kidney cyst with gallstones, CT scan - illustration

    A CT scan of the upper abdomen showing a fist-sized cyst of the left kidney and gallstones (the kidney cyst was found by chance; there were no symptoms).

    Kidney cyst with gallstones, CT scan

    illustration

  • Choledocholithiasis

    Choledocholithiasis - illustration

    About 15% of people with gallstones will develop stones in the common bile duct. The common bile duct is a small tube that carries bile from the gallbladder to the duodenum. Obstruction of the common bile duct may also lead to obstruction of the pancreatic duct because these ducts are usually connected. If the pancreatic duct is also obstructed, pancreatitis will likely develop.

    Choledocholithiasis

    illustration

  • Gallbladder

    Gallbladder - illustration

    The liver produces bile which aids in the digestion of fats. The bile travels through tiny canals which eventually drain through the common bile duct into the small intestine. The gallbladder stores excess bile that is not immediately needed for digestion.

    Gallbladder

    illustration

  • Gallbladder

    Gallbladder - illustration

    The gallbladder is a muscular sac located under the liver. It stores and concentrates the bile produced in the liver that is not immediately needed for digestion. Bile is released from the gallbladder into the small intestine in response to food. The pancreatic duct joins the common bile duct at the small intestine adding enzymes to aid in digestion.

    Gallbladder

    illustration

  • Bile pathway

    Bile pathway - illustration

    The biliary system is comprised of the organs and duct system that create, transport, store and release bile into the duodenum for digestion. Includes the liver, gallbladder and bile ducts (named the cystic, hepatic, common, and pancreatic duct).

    Bile pathway

    illustration

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Kidney cyst with gallstones, CT scan

      Kidney cyst with gallstones, CT scan - illustration

      A CT scan of the upper abdomen showing a fist-sized cyst of the left kidney and gallstones (the kidney cyst was found by chance; there were no symptoms).

      Kidney cyst with gallstones, CT scan

      illustration

    • Choledocholithiasis

      Choledocholithiasis - illustration

      About 15% of people with gallstones will develop stones in the common bile duct. The common bile duct is a small tube that carries bile from the gallbladder to the duodenum. Obstruction of the common bile duct may also lead to obstruction of the pancreatic duct because these ducts are usually connected. If the pancreatic duct is also obstructed, pancreatitis will likely develop.

      Choledocholithiasis

      illustration

    • Gallbladder

      Gallbladder - illustration

      The liver produces bile which aids in the digestion of fats. The bile travels through tiny canals which eventually drain through the common bile duct into the small intestine. The gallbladder stores excess bile that is not immediately needed for digestion.

      Gallbladder

      illustration

    • Gallbladder

      Gallbladder - illustration

      The gallbladder is a muscular sac located under the liver. It stores and concentrates the bile produced in the liver that is not immediately needed for digestion. Bile is released from the gallbladder into the small intestine in response to food. The pancreatic duct joins the common bile duct at the small intestine adding enzymes to aid in digestion.

      Gallbladder

      illustration

    • Bile pathway

      Bile pathway - illustration

      The biliary system is comprised of the organs and duct system that create, transport, store and release bile into the duodenum for digestion. Includes the liver, gallbladder and bile ducts (named the cystic, hepatic, common, and pancreatic duct).

      Bile pathway

      illustration

    A Closer Look

     

     

    Review Date: 4/20/2015

    Reviewed By: Subodh K. Lal, MD, gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

    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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