CHOLEDOCHOLITHIASIS/ MIRIZZI SYNDROME

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Choledocholithiasis also called common bile duct (CBD) stones is the presence of agallstone in the common bile duct. The bile duct is the small tubethat carries bile from the gallbladder to the intestine. Gallstonesusually form in your gallbladder, which is a pear-shaped organ belowyour liver in the upper-right side of your abdomen. These stonesusually remain in the gallbladder and may or may not cause symptoms.Many a time they may pass through the common bile duct unobstructed.Symptoms of choledocholithiasis develop if the stones get lodged andblock the bile duct

Symptomsof choledocholithias

Thepredominant symptoms include -

abdominalpain in the upper or right -upper abdomen

fever

jaundice(yellowing of the skin and eyes)

lossof appetite

nauseaand vomiting


Sometimesif the obstruction is severe, the bile gets infected and infectionspreads rapidly and leads to a condition called cholangitis.Cholangitis is a medical emergency and needs to be treatedappropriately at an early stage.



Diagnosingcholedocholithiasis

Yourphysician would subject you to the following tests to diagnosecholedocholithiasis

Bloodtests– these would reveal the the extent of jaundice and presence ofinfection and also indicate presence of cholangitis.

Ultrasoundabdomen

CTscan abdomen

Endosonography– Here a long flexible tube fitted with light and small ultrasoundprobe is passed into the oral cavity and stones in the CBD can bediagnosed and appropriate treatment instituted. Any other problemapart from stones can also be clearly visualised and biopsies takenif necessary.

ERCP– Here an endoscope – a long flexible tube fitted with light andcamera, is passed through your oral cavity and into the duodenum, anda dye is injected into the biliary system to diagnosecholedocholithiasis. Your physician may also be able to remove bileduct stone by ERCP. Once stones are cleared from the bile duct, latera laparoscopic surgery(laparoscopic cholecystectomy) would berequired to remove the gall bladder

Surgery– In case your physician is not able to remove bile duct stones byERCP, during laparoscopic cholecystectomy, a small incision can bemade on the bile duct and stones can be removed.

Ultimately,the type of treatment is based on the location and size of the stoneand the degree of technical expertise available to your treatingphysician.




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