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Common bile duct stone, also known as choledocholithiasis, is the presence of gallstones in the common bile duct.
Jaundice of the skin or eyes is an important physical finding in biliary obstruction.
Jaundice and/or clay-colored stool may raise suspicion of choledocholithiasis or even gallstone pancreatitis.
More than 70% of people with gallstones are asymptomatic and are diagnosed incidentally during ultrasound.
Some gall stones may be too large to pass through the common bile duct and may cause an obstruction: risk factor for this includes duodenal diverticulum.
An obstructive common bile duct stone may lead to jaundice, elevation in alkaline phosphatase, increase in conjugated bilirubin, increase in cholesterol in the blood, and cause acute pancreatitis and ascending cholangitis.
A CBD stone can also cause acute pancreatitis and ascending cholangitis.
Choledocholithiasis, the presents of stones in common bile duct is one of the complications of cholelithiasis.
Choledocholithiasis is suggested when the liver function blood test shows an elevation in bilirubin and serum transaminases.
Patients with cholelithiasis typically present with pain in the right-upper quadrant of the abdomen with the associated symptoms of nausea and vomiting, especially after a fatty meal.
The confirmation of the diagnosis of cholelithiasis with an abdominal ultrasound that shows the ultrasonic shadows of the stones in the gallbladder.
With pancreatic duct obstruction the at ampulla of vater may be associated with elevated lipase and amylase levels.
Choledocholithiasis is suggested when the liver tests shows an elevation in bilirubin and serum transaminases.
Indicators include raised indicators in ampulla of vater pancreatic duct obstruction, as lipases and amylases.
In prolonged cases the international normalized ratio (INR) may occur due to a decrease in vitamin K absorption.
In prolonged CBD obstruction decrease in vitamin K absorption can occur as decreased bile flow which reduces fat breakdown and absorption of fat soluble vitamins.
The diagnosis of CBD stone is confirmed with either a magnetic resonance cholangiopancreatography (MRCP), an endoscopic retrograde cholangiopancreatography (ERCP), or an intraoperative cholangiogram.
The benefit of ERCP is that it can be utilized not just to diagnose, but also to treat the problem.
If a cholecystectomy is required a cholangiogram during the surgery can be achieved: a stone in the bile duct may be flushed into the intestine or retrieve the stone back through the cystic duct.
ERCP may lead to widening the opening into the bile duct and remove the stone through that opening.
Treatment is by choledocholithotomy and endoscopic retrograde cholangiopancreatography (ERCP).
A treatment involves an operation called a choledocholithotomy, which is the removal of the gallstone from the bile duct using ERCP, although surgeons are now increasingly using laparoscopy with cholangiography.
If laparoscopy is unsuccessful, an open choledocholithotomy is performed.
Typically, the gallbladder is then removed, an operation called cholecystectomy, to prevent a future occurrence of common bile duct obstruction or other complications.
Choledocholithotomy, is the removal of the gallstone from the bile duct using ERCP, or laparoscopy with cholangiography.
The surgeon inserts a tube with an inflatable balloon to widen the CBD and the stones are usually removed using either a balloon or tiny basket.
If laparoscopy is unsuccessful, an open choledocholithotomy is performed.
An open choledocholithotomy procedure may be used in the case of large stones, when the duct anatomy is complex, during gallbladder operations when stones are detected, or when ERCP or laparoscopic procedures are not available.