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Choledocholithiasis Overview & Management

Choledocholithiasis is the presence of gallstones in the common bile duct, which can be single or multiple. Risk factors include female sex, older age, ethnicity, pregnancy, hormone therapy, obesity, genetics, diabetes, and certain medications or diets. Bile becomes supersaturated with cholesterol, calcium, or bilirubin and stones form in the gallbladder or common bile duct. A small stone may pass into the common bile duct and cause obstruction, inflammation (cholangitis), biliary spasm and pain, or backflow of bilirubin leading to jaundice and fever. Diagnosis involves ultrasound, MRCP, or endoscopic cholangiography. Treatment consists of preoperative imaging followed

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Eva Meltyza
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177 views4 pages

Choledocholithiasis Overview & Management

Choledocholithiasis is the presence of gallstones in the common bile duct, which can be single or multiple. Risk factors include female sex, older age, ethnicity, pregnancy, hormone therapy, obesity, genetics, diabetes, and certain medications or diets. Bile becomes supersaturated with cholesterol, calcium, or bilirubin and stones form in the gallbladder or common bile duct. A small stone may pass into the common bile duct and cause obstruction, inflammation (cholangitis), biliary spasm and pain, or backflow of bilirubin leading to jaundice and fever. Diagnosis involves ultrasound, MRCP, or endoscopic cholangiography. Treatment consists of preoperative imaging followed

Uploaded by

Eva Meltyza
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Choledocholithiasis

Definisi
Batu empedu di common bile duct yang dapat besar atau kecil serta dapat single atau multiple yang ditemukan pada 6-12% pasien
yang menderita batu empedu. Diklasifikasikan sebagai secondary common bile duct stones yang termasuk cholesterol stones.
Etiologi
1. Stones
2. ascaris lumbricoides
3. clonorchis sinensis
Epidemiology
Insidensinya meningkat pada:
1. Pada wanita, 20 - 25 % nya adalah usia diatas 60 tahun, multi parity
2. Untuk ras asia, biasanya sumbatan paling banyak di karenakan ascaris lumbricoides
Pemeriksaan fisik
1.
2.
3.
4.
5.

Tenderness, terutama di temukan di right upper quadrant atau mild epigastric


Mild icterus
Fever, hypotension
Nausea and vomiting
Transient jaundice, bila batunya completely impacted, dapat menyebabkan jaundice yang parah.

Lab finding
Peningkatan serum bilirubin, alkalin phosphatase dan transaminase
Diagnosis
1. USG: untuk mengetahui ukuran batunya dan melihat dilatasi common bile duct
2. MRC
3. Endoscopic cholangiography

Diagnosa Banding
1. Gallbladder cancer/ tumor
2. Cholangitis
3. Pancreatitis acute
4. Ascariasis
5. Cholescystitis
6. Abdominal trauma
7. Biliary colic/ biliary obstruction
Treatment
1. Preoperative endoscopic cholangiography atau intraoperative cholangiogram terlebih dahulu untuk melihat letak dan
memastikan keberadaan batunya.
2. Sphincterectomy
3. Laparoscopic cholecystectomy

Choledocolithiasis Pathophysiology
Risk factors
Non-modifiable
Sex (Females are more prone)
Age (75 y/o above Females = 50% Males = 20%)
Ethnicity (Native Americans such as Pima Indians,
Northern Europeans and South Americans)

Modifiable
Pregnancy
Use of Hormone Replacement Therapy (Estrogen)
Obesity
Weight-cycling

Genetics
Diabetes Mellitus
Metabolic Syndrome
Crohns Disease
Cirrhosis
Blood Disorders (Sickle cell Anemia)

Prolonged Parenteral feeding


Medications (Octeotrides)
Diet (Increase intake of Heme Iron, Fatty foods and Alcohol)

Bile becomes supersaturated with cholesterol or calcium or

excess unconjugated bilirubin or both and has decrease bile salts

The solute precipitates from solution to solid crystals


Crystals come together to form stones, either Cholesterol, Pigment or Mixed in the Gallbladder or Common Hepatic Duct
A small stone may pass from the gallbladder to the common hepatic duct
Obstruction in the common hepatic duct

Body tries
Nausea

to dislodge the stones


and Vomiting

Inflammation occurs
(Cholangitis)

Spasm of the biliary tracts


causing biliary colic or
pain in the RUQ

Backflow of conjugated
to Liver

may occur
Conjugated Bilirubin enters bloodstream

Fever is experienced
Jaundice occurs

Patient

becomes restless and

bilirubin

changes position frequently


to relieve pain

Presence of Icteric Sclera and


yellow skin

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