Choledocholithiasis: Symptoms and Treatment
Choledocholithiasis is a type of CSF, in which the concrements are found not in the bladder, but in the choledochus. And they can either get there from the gallbladder, or directly in the choledochus and form. People who have a gallbladder removed, the risk of developing a disease such as choledocholithiasis, increases at times, although in this case the disease often occurs asymptomatically. In most cases, the treatment of such a disease operative.
Note that the disease is serious enough, and especially in those cases when severe complications develop in the form of overlap, or there is a threat to life to the patient. Note that the disease is more common in men, and from people suffering from cholelithiasis, choledocholithiasis develops in 5-15% of cases. According to the ICD-10, the code for this disease is K80.5, but depending on the possible complications, the code can be changed to K80.3, K80.4 or K80.8.
The main reason why a person can have stones in the bile ducts is because of their migration from the gallbladder. Usually this happens in cases where the stones are small or medium in size, since a large stone is difficult to move from the place, and the more so it does not pass into the holedoch.
Migration of stones occurs because the contractility of the gallbladder increases or the pressure in the body increases. In these cases, the stones move from department to department, reaching the area where they are stuck. Or, if the concrement is very small in size, and when it moves along the ducts, there are no obstacles to it, it can go through holedoch and be in the pancreas. In this case, the disease has no symptoms.
As already mentioned above, the stones in holedoch can not only get from the bubble, but also form in it. This happens for various reasons:
- with surgery on the gallbladder or ducts
- with mechanical damage to the body
- In the inflammatory process in the bile ducts.
Some diseases, for example, cysts in the bile ducts that prevent normal bile flow, or primary sclerosing cholangitis, can also cause the development of pathology. If there are strictures in the choledocha, or if the ducts are clogged with worms or their eggs, there is also the possibility of forming concrements in a person and further obstruction of the ducts with severe symptoms.
In medical practice, there is residual choledocholithiasis and recurrent. The residual is said in those cases when the diagnosis has established the presence of multiple stones in the cholehod. Recurrent is characterized by the constant appearance of stones after a short time after their removal.
The signs of choledocholithiasis are quite clear, so diagnosis is usually easy. The first thing that a person complains of is this severe pain, which can be localized either in the epigastric region or in the right hypochondrium. Often such a pain gives in the back. On the nature of pain can be different, because it depends on the size of the stone found in the choledoch, and the attendant complications caused by it. More often painful, but it can also be paroxysmal, variable intensity.
If the stone moves down the choledoch, the pain becomes shrouded. If it passes into the pancreas, it stops completely, and the sick person can not experience any symptoms until the next attack occurs.
Other symptoms of a disease such as choledocholithiasis are:
- increase in body temperature at the peak of a pain attack
- jaundice, which is intermittent (that is, it can be more or less intense at different times, depending on the location of the calculus in the cholehod).
The temperature can also rise when the stone is stuck in the duct and the inflammatory process develops at the site of its localization. Then the patient’s condition worsens considerably — he can feel the expressed symptoms of intoxication (nausea, vomiting, weakness, dizziness, etc.).
The jaundice, which then becomes more intense, then weakens, is an indicative sign of such a disease as choledocholithiasis, so the diagnosis is based on the identification of this sign, which makes it possible to exclude the presence in humans of such diseases as leptospirosis, acute viral hepatitis or pancreatic head cancer .
Choledocholithiasis is terrible for its complications. In particular, due to complete overlapping of choledocha, cholangitis, pancreatitis or secondary biliary cirrhosis can develop. In this case, a person may have symptoms such as:
- darkening of the urine
- complete fecal discoloration;
- severe pain syndrome.
When the gallbladder is involved in the process, a person can complain of severe back pain, and if pancreatitis occurs, then continuous vomiting, surrounding pain and even intestinal paresis may occur.
In order to correctly diagnose and prescribe timely and full-fledged treatment of the disease, a diagnosis is needed, which includes various methods of examination. First, patients with suspected choledocholithiasis are assigned ultrasound, which allows to see the concrements in the bile duct or gall bladder, and determine their size. Also shown is taking biochemical liver samples.
One of the most reliable methods, which includes modern diagnostics of such a disease as choledocholithiasis, is percutaneous transhepatic cholangiography.
Timely diagnosis allows you to adequately assess the patient’s condition and choose the procedure for removing stones from choledoch, taking into account his current condition, location and size of the stones.
After the diagnosis is carried out, the patient is prescribed treatment for the disease. Mostly it is operative — conservative methods are shown only in those cases when the operation is contraindicated. In case the attack was repeated twice in a person, the operation to remove concrements is mandatory.
More often than not, an endoscopic stone removal surgery is used, which has no side effects and allows you to extract small and medium-sized calculi from choledocha. A similar method is a laparoscopic operation that allows the removal of stones from the patient’s bile ducts with minimal consequences.
In those cases where the calculi are too large and they can not be removed endoscopically or laparoscopically, a classical operation — choledochotomy — is shown. Sometimes, in case of development of complications, along with choledochhotomy spend and cholecystectomy, that is, remove not only the ducts, but also the gall bladder itself. The gallbladder is always removed if the attack of choledocholithiasis is repeated a second time.
Note that after the operation the patient is assigned a diet that allows his digestive system to function normally. Food that a person takes does not have to be fried or fatty, spicy or too salty. It shows the use of a large number of vegetables (better boiled).
The prognosis of the course of the disease is quite serious, since choledocholithiasis has serious consequences if it is not diagnosed in time and not treated in a timely manner. In addition, a quarter of patients after a choledochotomy have a relapse of the disease for five years.