Choledocholithiasis

Choledocholithiasis is a medical term used when an individual has a gallstone in a structure called common bile duct where bile passes from gallbladder to the intestine. ^[1] Gallstones can be primary, secondary, residual or recurrent. A primary stone is one which originates in the bile duct. Secondary stone comes from gallbladder but travels to the bile duct. Residual stone refers to a stone that was left out at the time of surgical operation called cholecystectomy which usually manifests in less than 3 years after the surgery. Lastly, recurrent stones are those that develop in ducts more than 3 years after an individual undergoes surgery. ^[2]

Epidemiology

Majority of cases in developed countries involve secondary stones. ^[2] Some ethnic groups like American Indians and Mexican-Americans are said to be more prone to develop gallstones while those from Asian descent are more likely to have stones located in the bile duct in particular. The chance to have the condition increases with age. Female predilection has been reported as well. ^[3]

Causes

Individuals who had history of gallstones or disease of the gallbladder have increased chances of having the condition. Even those patients who already have their gallbladder taken away via surgery may still develop choledocholithiasis. Some of the identified risk factors include being obese, pregnant, having sedentary lifestyle and people who are undergoing prolonged fasting. A diet which is high in fat and calories but low in fiber has been implicated to the development of choledocholithiasis. Genetics also is another essential factor. ^[3]

Signs and Symptoms

If there is an obstruction, the individual may experience symptoms including an abdominal pain positioned at the right or middle upper area which can radiate to the back or to the shoulder. There can also be yellowing of the skin and sclera of the eyes referred to as jaundice. Fever, nausea and vomiting are also common. ^[4]

Diagnosis

To identify the location of the stones, laboratory exams like abdominal ultrasound Endoscopic Retrograde Cholangiography (ERCP), Magnetic Resonance Cholangiopancreatography (MRCP) and CT scan can be performed. Blood tests can also be requested. ^[5]

Treatment

Stones may be taken out or be allowed to pass through the duct in procedures like ERCP or sphincterotomy. Depending on the case, other surgical processes may be needed. ^[5]

References:

1.      http://health.nytimes.com/health/guides/disease/choledocholithiasis/overview.html

2.    http://www.merckmanuals.com/professional/hepatic_and_biliary_disorders/gallbladder_and_bile_duct_disorders/choledocholithiasis_and_cholangitis.html

3.      http://www.healthline.com/health/choledocholithiasis

4.      http://www.pennmedicine.org/encyclopedia/em_PrintArticle.aspx?gcid=000274

5.      http://www.nlm.nih.gov/medlineplus/ency/article/000274.htm