hepatic and biliary disorders
Choledocholithiasis and Cholangitis
Introduction
Choledocholithiasis is the presence of stones in bile ducts; the stones can form in the gallbladder or in the ducts themselves. These stones cause biliary colic, biliary obstruction, gallstone pancreatitis, or cholangitis (bile duct infection and inflammation). Cholangitis, in turn, can lead to strictures, stasis, and choledocholithiasis. Diagnosis usually requires visualization by magnetic resonance cholangiopancreatography or endoscopic retrograde cholangiopancreatography. Early endoscopic or surgical decompression is indicated. (See also Overview of Biliary Function .) Stones may be described as Primary stones (usually brown pigment stones), which form in the bile ducts Secondary stones (usually cholesterol), which form in the gallbladder but migrate to the bile ducts Residual stones, which are missed at the time of cholecystectomy (evident<3 years later) Recurrent stones, which develop in the ducts>3 years after surgery 85% of common duct stones are secondary ( General reference ); affected patients have additional Bile duct stones may pass into the duodenum asymptomatically. Biliary colic occurs when the ducts become partially obstructed. More complete obstruction causes duct dilation, Jaundice and, eventually, cholangitis (a bacterial infection). Stones that obstruct the ampulla of Vater can cause gallstone pancreatitis. Some patients (usually those who are older) present with biliary obstruction due to stones that have caused no symptoms previously. , bile duct obstruction allows bacteria to ascend from the duodenum. Most (85%) cases ( General reference ) result from common bile duct stones, but bile duct obstruction can result from tumors or other conditions (see table Suspect acute cholangitis (a surgical emergency) in patients with abdominal pain, jaundice, and fever or chills. (Oriental cholangiohepatitis, hepatolithiasis) is characterized by intrahepatic brown pigment stone formation. This disorder occurs in Southeast Asia. It consists of Pathophysiology and bacterial debris in the bile ducts. Undernutrition and parasitic infestation (eg, In AIDS Cholangiopathy or cholangitis, direct cholangiography may show abnormalities similar to those in 