This condition arises due to one or more gallstones within any bile duct.
The ducts involved are the common hepatic, bile duct, and cystic duct.
The gallbladder is an organ of the digestive system that has the shape of a pear and is located under the liver in the upper right area of the abdomen.
This is the organ where stones are usually formed; these remain in the gallbladder or pass through a small tube, called the common bile duct, without obstruction until reaching the intestine.
Causes of choledocholithiasis
Choledocholithiasis is a pathology caused by the presence of gallstones inside the bile ducts, and the formation of these varies in cause and type:
- Gallstones: These brownstones form inside the bile ducts, usually in the common bile duct.
- Cholesterol gallstones: These stones are yellowish-green and are formed inside the gallbladder and are caused by high levels of cholesterol bile, bilirubin, or not enough bile salts. Another cause is that the gallbladder does not empty or does not open as often.
- Mixed bile stones: Gallstones resulting from two or more substances, including calcium, phosphate, protein, and cystine.
Gallstones are divided into residual and recurrent:
- Residual gallstones: Residual stones may remain after surgical intervention to remove the gallbladder ( cholecystectomy ). Usually, they appear after three years after having undergone the procedure.
- Recurrent gallstones: Recurrent gallstones continue to develop within the bile ducts even after removing the gallbladder.
Choledocholithiasis produces symptoms when there is a blockage in the bile duct, experiencing the following:
- Pressure or pain in the upper right area of the abdomen may be sporadic or may persist; when the pain is intense, emergency medical treatment is required.
- Jaundice (yellowing of the skin and eyes).
- Loss of appetite
- Nausea and vomiting.
- Stools of clay color.
- Dark urine.
When there is a gallstone obstruction, the bile can become infected.
The bacteria that cause the infection can spread quickly, pass to the liver, and become a life-threatening infection.
Complications such as biliary cirrhosis and pancreatitis may occur.
Diagnosis of choledocholithiasis
In addition to the routine physical examination, the differential diagnosis may require imaging tests:
- Transabdominal ultrasound: Examines the spleen, kidneys, liver, gallbladder, and pancreas.
- Abdominal computed tomography: Transverse radiographs of the abdomen.
- Endoscopic ultrasound: To examine the digestive tract.
- Endoscopic retrograde cholangiography: To identify tumors, stones, and narrowing of the bile ducts.
- Magnetic resonance cholangiopancreatography: Magnetic resonance imaging of the bile ducts, gallbladder, and pancreatic duct.
- Percutaneous transhepatic cholangiography: An x-ray of the bile ducts.
Several laboratory tests are performed to detect an infection and to confirm the function of the liver and pancreas:
- Complete hematology.
- Pancreatic enzymes.
- Liver function tests.
People with a history of gallstones or gallbladder disease have risk factors and may experience this condition, in addition to the following factors:
- Low fiber diet, high in calories and fats and refined carbohydrates.
- The pregnancy.
- The prolonged fasting.
- Rapid weight loss
- Lack of daily physical activity.
- Female sex and having high levels of estrogen.
- In hormone replacement therapy or the use of contraceptives.
- Age over 40 years.
- A family history of gallstones.
- Descendants of Native Americans or Mexican-American.
- Rapid weight loss
- Have an account of gastrointestinal conditions ( Crohn’s disease ).
- Presenting diabetes, metabolic syndrome, or insulin resistance.
- Having infections of the bile duct system or cirrhosis.
- Having hemolytic anemia (sickle cell disease).
Treatment of choledocholithiasis
The treatment of choledocholithiasis focuses on relieving the blockage.
These treatments include:
- Extraction of the calculation.
- Fragmentation of the calculus (lithotripsy).
- Surgery to remove the gallbladder and stones ( cholecystectomy ).
- Surgery in the common bile duct to extract stones or help them in their passage (sphincterotomy endoscopy).
- Stenting biliar.