CHOLEDOCHOLITHIASIS/ MIRIZZI SYNDROME

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Choledocholithiasis also called common bile duct (CBD) stones is the presence of a gallstone 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 and block the bile duct

Symptoms of choledocholithiasis

The predominant symptoms include -

abdominal pain in the upper or right -upper abdomen

fever

jaundice(yellowing of the skin and eyes)

loss of appetite

nausea and vomiting


Sometimes if the obstruction is severe, the bile gets infected and infection spreads rapidly and leads to a condition called cholangitis. Cholangitis is a medical emergency and needs to be treated appropriately at an early stage.



Diagnosingcholedocholithiasis

Your physician would subject you to the following tests to diagnose choledocholithiasis

Blood tests– these would reveal the the extent of jaundice and presence of infection and also indicate presence of cholangitis.

Ultrasound abdomen

CTscan abdomen

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

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

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

Ultimately,the type of treatment is based on the location and size of the stone and the degree of technical expertise available to your treating physician.




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