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CBD Stone / Choledocolithiasis Introduction Common Bile Duct (CBD) is a tube that carries bile fromDr. Sanjiv Haribhakti Gisurgery.info " id="pdf-obj-0-2" src="pdf-obj-0-2.jpg">

CBD Stone / Choledocolithiasis

Introduction

Common Bile Duct (CBD) is a tube that carries bile from gallbladder or liver to the small intestine. CBD stone also known as duct stone or choledocolithiasis is a presence of a gallstone in the common bile duct. Gallstone usually forms inside the gallbladder which is a pear shaped organ below the liver. These stone usually remains in gallbladder however sometime it migrates into common bile duct and gets tucked obstructing the passage this condition is called choledocolithiasis or CBD stone.

Signs & Symptoms

CBD stones may not have any signs & symptoms for months or even years. However, if the blockage becomes severe, the following signs & symptoms may be experienced:

• Pain in the upper or middle part of abdomen • Fever • Jaundice • Loss of appetite • Nausea & vomiting

Causes

Gallstone may develop when there is too much cholesterol or bilirubin inside gallbladder secreted by the liver.

Too much cholesterol: Bile usually dissolves or break down cholesterol however if the liver produces more cholesterols than the bile can dissolve it results in formation of hard stones called cholesterol gall stones.

Too much Bilirubin: Bilirubin is a chemical that is produced when the body breaks down old red blood cells. In some cases such as cirrhosis of the liver and certain blood disorders the liver produces too much bilirubin which contributes to the gallstone formation.

Poor emptying of Gallbladder: If the gallbladder often fails to get empty completely the bile may becomes overly concentrated leading to formation of gallstones.

Risk Factors

Following are the risk factors of developing CBD stone:

• Obesity • Prolonged fasting • Rapid weight loss • Lethargic lifestyle • Pregnancy • Age & Gender: older people and women are more likely to have CBD stone • Family history of gallbladder disease

Complications

• Acute Cholangitis: CBD stone can cause infection in the bile. The bacteria from the infection can spread rapidly. It can move into the liver or ductal system. It can become a life threatening infection • Hepatic Abscess • Billiary cirrhosis • Pancreatitis

Diagnosis

Abdominal CT Scan: it is a digital imaging test that takes pictures of the liver and abdominal region revealing the presence of gallstone if any.

Ultrasound: this test uses ultrasonic sound waves to create image of abdominal organs which help find presence of any gallstone.

Endoscopic Ultrasound (EUS): an ultrasound probe is inserted on a flexible endoscopic tube and inserted through mouth to examine the digestive tract. Endoscopic Retrograde Cholangiography (ERCP): it is a procedure used to identify stones, tumors and narrowing in the bile ducts. An endoscopic tube is inserted through the mouth and dye is injected into the ducts where they can be visualized with x rays.

Magnetic Resonance Imaging (MRI): MRI scans of the gallbladder, bile ducts and pancreatic duct called Magnetic Resonance Cholangiopancreatography (MRCP).

Blood tests: to look for amount of bilirubin in the blood and to determine the functioning of liver.

Treatment

The treatment of CBD stone includes one or more of following:

• Stone extraction

• Lithotripsy: breaking the stone into small pieces allowing them to pass through • Cholecystectomy: surgery to remove gallbladder and stone • Sphincterotomy: surgery to make a cut into the common bile duct to remove stones or help them pass • Biliary stenting • Laparoscopic CBD exploration • Endoscopic Sphincterotomy is the most common treatment of CBD stone.

During this procedure a balloon or basket type device is inserted into the bile duct and used to extract the stones.

Lifestyle changes such as physical activity and dietary changes such as increasing fiber and decreasing saturated fats can reduces the chances of developing CBD stones.