choledocholithiasis

Question 1

What is the definition of choledocholithiasis?

Answer 1

-The presence of gallstones in the common bile duct

Question 2

What are the clinical signs of choledocholithiasis?

Answer 2

1. colicky RUQ or epigastric pain
   - more severe and painful than cholelithiasis and lasts for 6 hours
   - nausea and vomiting
   - postprandially

Question 3

What are the signs of extrahepatic cholestasis?

Answer 3

-jaundice
-pruritis
-
-

Question 4

What diagnostic tests do we do for choledocholithiasis?

Answer 4

1. laboratory tests: Increased ALP, Increased GGT, Increased direct and total bilirubin
2. Imaging: abdominal ultrasound, MRCP, ERCP, EUS
3. Liver function tests-AST, ALT

Question 5

What are the clinical features seen on the trans-abdominal ultrasound

Answer 5

-dilated common bile duct

Question 6

When we do further confirmatory tests like ERCP,MRCP nad EUS?

Answer 6

If it is a high risk we do ERCP

• medium risk MRCP or EUS
• Low risk then just treat cholethiasis

Question 7

What does ERCP stand for?

Answer 7

-endoscopic retrograde cholangiopancreatography

Question 8

What is the treatment for choledocholithiasis?

Answer 8

1. conservative treatment: spasmolytics, analgesia

2. definitive Treatment: use ERCP to remove the obstruction

Question 9

How does ERCP work?

Answer 9

• both diagnostic and therapeutic

- the stone is extracted using a DORMIA basket

Question 10

What are indications for using ERCP?

Answer 10

• choledocholithias
• acute cholangitis
• pancreatic gallstones

Question 11

What are the complications of ERCP?

Answer 11

• haemorrhage
• cholangitis
• perforation
• post ERCP-pancreatitis(happens in 5%)

Question 12

What procedure is needed to prevent choledocholithiasis?

Answer 12

-cholecystectomy: must be done 72 hours after ERCP

Question 13

What are the complications of choledocholithiasis?

Answer 13

-gallstone ileus

gallstone pancreatitis

Question 14

What are the clinical signs of gallstone ileus?

Answer 14

• pneumobilia which means the accumulation of gas in the biliary system
• nausea and vomiting and abdominal distension and pain
• perforation and fistula formation can occur that leads to the movement of the stones into the bowel lumen

Question 15

What is the cause of choledocholithiasis?

Answer 15

1. secondary cause is the most common cause: from cholithiasis which means the gallstones travel to common bile duct and obstruct which leads to spasm of biliary tract
2. primary cause is the least cause: intraductal stone formation due to cystic fibrosis

Question 16

What is the average size of a common bile duct?

Answer 16

<8-9mm

if it is bigger than 10mm it is abnormal

Question 17

If we try to do a ERCP and it fails the first time what must we try and do?

Answer 17

-repeat the ERCP and stent in between to drain the bile