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    Common Bile Duct (CBD) Stone (Choledocholithiasis)

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    Manurun Londong Allo
    The document discusses the anatomy and pathophysiology of gallstones and common bile duct stones. It describes the locations where stones can form, including the gallbladder, cystic duct, common bile duct, and common hepatic duct. Risk factors for cholesterol and pigment stones are outlined. Symptoms of common bile duct stones blocking the duct are also summarized, along with methods for diagnosis and potential complications.

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    Common Bile Duct (CBD) Stone (Choledocholithiasis)

    Uploaded by

    Manurun Londong Allo
    83 views4 pages
    The document discusses the anatomy and pathophysiology of gallstones and common bile duct stones. It describes the locations where stones can form, including the gallbladder, cystic duct, common bile duct, and common hepatic duct. Risk factors for cholesterol and pigment stones are outlined. Symptoms of common bile duct stones blocking the duct are also summarized, along with methods for diagnosis and potential complications.

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    The document discusses the anatomy and pathophysiology of gallstones and common bile duct stones. It describes the locations where stones can form, including the gallbladder, cystic duct, common bile duct, and common hepatic duct. Risk factors for cholesterol and pigment stones are outlined. Symptoms of common bile duct stones blocking the duct are also summarized, along with methods for diagnosis and potential complications.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    83 views4 pages

    Common Bile Duct (CBD) Stone (Choledocholithiasis)

    Uploaded by

    Manurun Londong Allo
    The document discusses the anatomy and pathophysiology of gallstones and common bile duct stones. It describes the locations where stones can form, including the gallbladder, cystic duct, common bile duct, and common hepatic duct. Risk factors for cholesterol and pigment stones are outlined. Symptoms of common bile duct stones blocking the duct are also summarized, along with methods for diagnosis and potential complications.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 4

    Anatomy of Biliary tree

    Common bile duct (CBD) stone (Choledocholithiasis) Choledocholithiasis is a disease of the common bile duct. The common bile duct forms at the junction of the cystic duct (from the gallbladder) and the common hepatic duct (from the liver). It drains bile into the duedenum (the first part of the small intestine).

    Location of Gall stone 1. 2. 3. 4. Gallbladder (Cholecystolithiasis) Cystic duct (Cysticolithiasis) Common bile duct (Choledocholithiasis) Common hepatic duct (Hepatolitiasis)

    Type of CBD stone 1. Cholesterol stones 2. Pigment stones a. Black-pigment stones b. Brown-pigment stones Risk Factor cholesterol stones include: o o o High serum cholesterol leves Increased age Female sex

    o o o o

    Obesity Rapid weight loss The contraceptive pill Total parenteral nutrition

    pigment stones include: o o o Chronic haemolysis (red blood cell breakdown) -hereditary spherocytosis Sickle cell disease, as well as liver cirrhosis. They may also form in the bile ducts after cholecystectomy (surgical

    removal of the gallbladder).

    Clinical manifestation Symptoms usually do not occur unless the stone blocks the common bile duct. Symptoms that may occur include: o Abdominal pain in the right upper or middle upper abdomen that may: o Be steady o Be sharp, cramping, or dull o Spread to the back or below the right shoulder blade o Fever o Loss of appetite o Jaundice (yellowing of skin and whites of eyes) o Nausea and vomiting

    How is Common Bile Duct Stone diagnosed Clinical symptom & Clinical examination Laboratory test :

    Full blood count - elevated white cell count signifying infection. Liver function tests - elevated bilirubin, evidence of stasis. Blood cultures - frequently positive in cholangitis. Amylase/Lipase - may be elevated if there is an element of pancreatitis.

    Imaging Abdominal CT scan

    Complication

    Abdominal ultrasound Endoscopic retrograde cholangiography (ERCP) Endoscopic ultrasound Magnetic resonance cholangiopancreatography (MRCP) Percutaneous transhepatic cholangiogram (PTCA)

    Biliary cirrhosis Cholangitis Pancreatitis

    Treatment o Surgery : ERCP and a procedure called a sphincterotomy o Laparascopic Cholecystectomy + pre op ERCP o Laparascopic cholecystectomy + intra op ERCP o Laparascopic Cholecystectomy + CBD exploration(transcystic / choledochotomy) o open cholecystectomy + CBD exploration

    Surgery risk The major risk of an ERCP is the development of pancreatitis Heart and lung problems Bleeding after sphincterotomy Infection in the bile duct (cholangitis) perforation (a tear in the intestine) Over sedation can result in dangerously low blood pressure, respiratory depression, nausea, and vomiting.

    Pathogenesis
    PREDISPOSING/ NON-MODIFIALBE GENDER: FEMALE AGE: 40 MULTIPAROUS PRECIPITATING/ MODIFIABLE LIFESTYLE FERTILE DISEASE

    AGEING ESTROGEN IN WOMEN USE OF ORAL CONTRACEPTIV ES

    MEDICATION SUCH AS CLOFIBRATE

    ILEAL DISEASE INTESTINAL BYPASS SURGERY

    PREGNANCY STARVATION RAPID WEIGHT LOSS

    FATTY LIVER

    SERUM CHOLESTEROL LEVELS

    BILE ACID SYNTHESIS

    MALABSORPTION OF BILE SALTS

    BILE COMBINES WITH CHOLESTEROL IN THE LIVER

    EXCRETION OF GALL BLADDER SLUDGE

    HEPATIC SECRETION OF SUPER SATURATED

    EMULSIFICATION OF CHOLESTEROL

    SLUGGISH BILE FLOW

    CHEMICAL IRRITATION TO BALLDER

    PRECIPITATION OF CHOLESTEROL/PI GMENT CRYSTALS CHOLESTEROL/PIGM ENT STONE FORMATION IN THE GALL BLADDER

    CHOLECYS TITIS

    INFLAMMATION OF THE GALLBLADDER

    CHOLELITHIASIS

    STONE FORMATION IN THE HEPATIC DUCT DISLODGEME NT OF STONE IN THE COMMON

    NAUSEA/VOMITING FEVER CHILLS PAIN ALTERATION IN THE ABSORPTIVE CHARACTERISTIC OF THE MUCOSAL LAYER EXCESSIVE BELCHING ABDOMINAL DISTENTION PAIN ABSORPTION OF WATER AND BILE SALTS CHOLEDOCOLITHIASIS OBSTRUCTION OF GALL STONES AND INFLAMMATIO N OF THE COMMON BILE DUCT

    SIGNS/SYMPTOMS MANIFESTED ON THE PATIENT: BILIARY COLIC

    SUPER SATURATION OF CHOLESTEROL IN THE BILE ON THE GALL BLADDER

    JAUNDICE YELLOWISH CONJUNCTIVA TENDERNESS IN THE RIGHT UPPER QUADRANT OF THE ABDOMEN

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