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CHOLEDOCHOLITHIASIS
Dr.B.Selvaraj MS;Mch;FICS;
Professor Of Surgery
Melaka Manipal Medical college
Melaka 75150 Malaysia
Choledocholithiasis- Overview
Causes of obstructive jaundice
Classical clinical vignette
Etiopathogenesis
Clinical features & complications
Investigations
Treatment
Mindmap of Choledocholithiasis
Diagnostic Algorithm in obstructive jaundice
Management algorithm in choledocholithiasis
Obstructive Jaundice- Causes
• Intraluminal causes:
- Choledocholithiasis
- Clonorchis sinensis
- Ascariasis & Schitosomiasis
• Mural causes:
- Malignant stricture-cholangiocarcinoma
- Benign stricture- Scelerosing cholangitis
• Extrinsic Causes:
- Ca Head of Pancreas
- Periampullary Carcinoma, Portal LN
Classical Clinical
Vignette
A 40-year-old female presents with a 24 hour history of right upper
quadrant (RUQ) and epigastric pain, associated with nausea and
vomiting. She has had similar pain in the past, particularly after
eating fatty foods. According to her family, over the last few hours,
the patient has become slightly confused. Past medical history is
negative.
O/E: She is moderately tender in the RUQ to deep palpation. She has
slight scleral icterus. She has noted dark- coloured urine. The
remainder of her abdominal exam is negative.
Vitals: BP-90/60 mms of Hg; PR-110/mt; RR-16/mt;T:102*F
Classical Clinical Vignette
CHOLEDOCHOLITHIASIS
WITH CHOLANGITIS
Laboratory examination:
TWBC- 15,000/μL(4 to 11,000/μL),
Total bilirubin-4mgm/dl(0.1 to 1.2mgm/dl) Direct bili- 3mgm/dl
ALP- 350μ/L (33-131μ/L); GGT- 330μ/L (8-88μ/L)
AST- 300μ/L(5-35μ/L); ALT- 280μ/L(7-56μ/L)
Sr Amylase- 100μ/L( 30-110μ/L)
Urine is positive for bilirubin
Choledocholithiasis-Etiology