Choledocholithiasis is the presence of stones in the common bile duct, also called common bile duct, resulting in symptoms such as abdominal pain in the upper right side, nausea, fever or yellowing of the skin and eyes.
Stones in the common bile duct can be formed by cholesterol, pigments and/or lipids, and some factors can increase the risk of their formation, such as obesity, a diet rich in fat and sugar, or pregnancy, for example.
The treatment of choledocholithiasis is carried out by a hepatologist, gastroenterologist or general practitioner, and involves removing the stones from the common bile duct through surgery.
Symptoms of choledocholithiasis
The main symptoms of choledocholithiasis are:
- Abdominal pain in the upper right side;
- Pain that can radiate to the back;
- Fever or chills;
- Nausea and vomiting;
- Loss of appetite;
- Yellow skin and eyes (jaundice);
- Itching on the body;
- Light stools and dark urine.
The pain from choledocholithiasis can be moderate or severe, and sometimes appear irregularly or be prolonged.
If you experience severe pain, mental confusion or low blood pressure, you should go to the hospital immediately, as it is a medical emergency that requires immediate care.
How to confirm the diagnosis
The diagnosis of choledocholithiasis is made by a hepatologist, gastroenterologist or general practitioner, through evaluation of symptoms, health history and physical examination.
In addition, the doctor should order blood tests, such as a complete blood count, and levels of alkaline phosphatase, bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma glutamyl transferase (GGT), which evaluate liver function.
Make an appointment with a hepatologist in the nearest region:
To confirm the diagnosis, the doctor must request an ultrasound in which it is possible to check the dilation of the common bile duct and the presence of stones.
If the ultrasound gives a negative result, the doctor may also request an MRI, to confirm the diagnosis and rule out other conditions with similar symptoms, such as cancer or narrowing of the bile duct, or choledochal cyst, for example.
Possible causes
Choledocholithiasis is caused by the formation of stones within the common bile duct or common bile duct, or by the passage of gallstones into the common bile duct.
Some factors may increase the risk of developing choledocholithiasis, such as:
- Genetic factors;
- Food rich in fat and sugar;
- Pregnancy;
- Obesity;
- Rapid weight loss associated with bypass surgery or calorie and fat restrictive diets;
- Cirrhosis of the liver;
- Sickle cell anemia.
Additionally, prolonged fasting in people receiving total parenteral nutrition may also increase the risk of choledocholithiasis.
Other factors that can also contribute to the development of stones in the bile ducts are the use of medications, such as estrogen, clofibrate or somatostatin analogues, for example.
Types of choledocholithiasis
There are two types of choledocholithiasis that are classified according to the origin of the stone in the bile duct:
- Primary choledocholithiasis: the stone is formed within the common bile duct or common bile duct, formed mainly by black or brown pigments;
- Secondary choledocholithiasis: The stone forms in the gallbladder and moves to the common bile duct, made mainly of cholesterol.
The type of choledocholithiasis is identified by the doctor through diagnostic tests.
How the treatment is carried out
The treatment of choledocholithiasis is carried out in the hospital by a hepatologist, gastroenterologist or general practitioner through surgery to remove stones from the common bile duct.
Surgery to remove stones from the common bile duct can be performed through endoscopy, called endoscopic retrograde cholangiography (ERCP), and is normally indicated for primary choledocholithiasis.
In cases of secondary choledocholithiasis, surgery called cholecystectomy may also be performed, in which the gallbladder is removed. See what recovery from gallbladder surgery is like.
Possible complications
Some complications of choledocholithiasis are:
- Cholangitis, which is inflammation of the bile ducts;
- Biliary pancreatitis;
- Cirrhosis;
- Liver or kidney failure.
In addition, surgery complications may also occur, such as post-ERCP pancreatitis, infections, retention or recurrence of stones, damage to the bile duct or liver blood vessels, or sepsis, for example.
