Choledocholithiasis (patient information)

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 * Assistant Editor-in-Chief: Meagan E. Doherty

Overview
Choledocholithiasis is the presence of a gallstone in the common bile duct. The stone may consist of bile pigments or calcium and cholesterol salts.

What are the symptoms of Choledocholithiasis?
Symptoms usually do not occur unless the stone blocks the common bile duct. Symptoms that may occur include:
 * Abdominal pain in the right upper or middle upper abdomen that may:
 * Come and go
 * Be sharp, cramping, or dull
 * Spread to the back or below the right shoulder blade
 * Get worse after eating fatty or greasy foods
 * Occurs within minutes of a meal
 * Fever
 * Loss of appetite
 * Jaundice (yellowing of skin and whites of eyes)
 * Nausea
 * Vomiting

What are the causes of Choledocholithiasis?
While stones can frequently pass through the common bile duct into the duodenum, some stones may be too large to pass through the CBD and will cause an obstruction.

Who is at risk for Choledocholithiasis?
Risk Factors include:
 * A previous medical history of gallstones

Choledocholithiasis can occur in people who have had their gallbladder removed

How to know you have Choledocholithiasis (Diagnosis)?
Tests that show the location of stones in the bile duct include the following:
 * Abdominal CT scan
 * Abdominal ultrasound
 * Endoscope retrograde cholangiography (ERCP)
 * Endoscopic ultrasound
 * Magnetic resonance cholangiopancreatography (MRCP)
 * Percutaneous transhepatic cholangiogram (PTCA)

Your doctor may order the following blood tests:
 * Bilirubin
 * Liver function tests
 * Pancreatic enzymes

When to seek urgent medical care
Call for an appointment with your health care provider if abdominal pain with or without fever develops that is not attributable to other causes, if jaundice develops, or if other symptoms suggestive of choledocholithiasis occur.

Treatment options
The goal of treatment is to relieve the blockage.

Treatment may involve:
 * Surgery to remove the gallbladder and stones
 * ERCP and a procedure called a sphincterotomy, which makes a surgical cut into the muscle in the common bile duct.

Diseases with similar symptoms

 * Cholecystitis
 * Perforated peptic ulcer
 * Acute peptic ulcer exacerbation
 * Amoebic liver abscess
 * Acute amoebic liver colitis
 * Acute pancreatitis
 * Acute intestinal obstruction
 * Renal colic
 * Acute retrocolic appendicitis

Where to find medical care for Choledocholithiasis
Directions to Hospitals Treating Choledocholithiasis

What to expect (Outlook/Prognosis)
Blockage and infection caused by stones in the biliary tract can be life threatening. However, with prompt diagnosis and treatment, the outcome is usually very good.

Possible Complications

 * Biliary cirrhosis
 * Cholangitis
 * Pancreatitis