Summary about Disease
Choledocholithiasis refers to the presence of gallstones in the common bile duct. The common bile duct carries bile from the gallbladder and liver to the small intestine. These stones can block the duct, causing a buildup of bile, which can lead to inflammation, infection, and damage to the liver, gallbladder, and pancreas.
Symptoms
Symptoms can vary depending on the size and location of the stones, and whether they are causing a blockage. Common symptoms include:
Abdominal pain (usually in the upper right or center)
Jaundice (yellowing of the skin and eyes)
Fever
Nausea and vomiting
Dark urine
Light-colored stools
Cholangitis (inflammation of the bile ducts): severe abdominal pain, high fever, chills, jaundice.
Causes
Choledocholithiasis usually occurs when gallstones that formed in the gallbladder pass into the common bile duct. Risk factors for gallstone formation include:
Female sex
Obesity
Rapid weight loss
Certain medications
Family history of gallstones
Increasing age
Certain medical conditions (e.g., diabetes, Crohn's disease)
Medicine Used
While medications can dissolve certain types of gallstones, they are not typically the primary treatment for choledocholithiasis due to the location of the stones in the bile duct. Medications may be used to manage symptoms or complications.
Pain relievers: To manage abdominal pain.
Antibiotics: To treat cholangitis (bacterial infection of the bile ducts).
Ursodeoxycholic acid (Actigall, Urso): In rare cases, to dissolve small cholesterol stones (less effective in the common bile duct). The primary treatment involves removing the stones through procedures like ERCP (Endoscopic Retrograde Cholangiopancreatography) or surgery.
Is Communicable
No, choledocholithiasis is not communicable. It is not caused by an infectious agent and cannot be spread from person to person.
Precautions
Maintain a healthy weight.
Eat a healthy diet low in saturated and trans fats, and high in fiber.
Avoid rapid weight loss.
Manage underlying medical conditions.
If you have gallstones, discuss potential treatment options with your doctor to prevent them from migrating into the bile duct.
How long does an outbreak last?
Choledocholithiasis is not an "outbreak" in the infectious disease sense. The duration of symptoms varies greatly. If a stone passes spontaneously, symptoms may resolve quickly. If a stone blocks the duct and isn't treated, symptoms can persist and worsen, leading to complications like cholangitis or pancreatitis, which can be life-threatening. Untreated Choledocholithiasis will persist until intervention.
How is it diagnosed?
Blood tests: Liver function tests (LFTs) will often be elevated, indicating bile duct obstruction.
Ultrasound: Can detect gallstones in the gallbladder, but may not always visualize stones in the common bile duct.
Endoscopic Ultrasound (EUS): A scope with an ultrasound probe on the end is passed down the esophagus to get close to the bile duct and pancreas.
Magnetic Resonance Cholangiopancreatography (MRCP): A non-invasive MRI scan that provides detailed images of the bile ducts and pancreas.
Endoscopic Retrograde Cholangiopancreatography (ERCP): An invasive procedure where a scope is passed through the mouth to the small intestine, and dye is injected into the bile ducts to visualize them on X-ray. ERCP can also be used to remove stones.
CT Scan: Can sometimes detect stones and assess complications.
Timeline of Symptoms
The timeline of symptoms can vary.
Early stages: Intermittent abdominal pain, often after eating fatty meals. Pain may be mild and easily dismissed.
Progression: As the stone blocks the duct, pain becomes more constant and severe. Jaundice may develop.
Complications: If the blockage persists, cholangitis or pancreatitis can develop, leading to high fever, chills, and severe abdominal pain. These are serious and require immediate medical attention.
Important Considerations
Choledocholithiasis can lead to serious complications, including cholangitis (a life-threatening infection) and pancreatitis.
Early diagnosis and treatment are essential to prevent these complications.
Treatment typically involves removing the stones, often with ERCP.
If gallstones are present in the gallbladder, cholecystectomy (gallbladder removal) may be recommended to prevent future episodes of choledocholithiasis.
Even after treatment, there is a small chance of recurrence.