Choledocholithiasis: Causes, Symptoms, Diagnosis, Risk Factors and Treatment

This is a condition that arises due to the presence of one or more gallstones within any bile duct.

The ducts involved are the common hepatic, the common bile duct and the 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

The choledocholithiasis is a pathology caused by the presence of gallstones inside the bile ducts and the formation of these vary in cause and type:

  • Gallstones: These stones are brown stones that 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 because the gallbladder does not empty completely or does not empty as often.
  • Mixed bile stones : These are gallstones resulting from a combination of two or more substances, which include calcium, phosphate, protein and cystine.

Gallstones are divided into residual and recurrent:

  • Residual gallstones: It is possible that residual stones may remain after surgical intervention for the removal of the gallbladder ( cholecystectomy ). Usually, they appear after three years after having undergone the procedure.
  • Recurrent gallstones: Recurrent gallstones are those that continue to develop within the bile ducts even after the gallbladder has been removed.

symptom

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.
  • Fever.
  • Jaundice (yellowing of the skin and eyes).
  • Loss of appetite
  • Nausea and vomiting.
  • Stools of clay color.
  • Dark urine.

When there is an obstruction of a gallstone, the bile can become infected.

The bacteria that cause the infection can spread quickly, passing to the liver, becoming 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.
  • Bilirubin
  • Pancreatic enzymes.
  • Liver function tests.

Risk factor’s

People with a history of gallstones or gallbladder disease have risk factors and may experience this condition, in addition to the following factors:

  • Obesity.
  • 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.
  • Descendant of Native Americans or Mexican-American.
  • Rapid weight loss
  • Have a history 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.

Research has not shown that medications are an effective treatment for choledocholithiasis.