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Digestive system
Digestive system


Kidney cyst with gallstones, CT scan
Kidney cyst with gallstones, CT scan


Choledocholithiasis
Choledocholithiasis


Gallbladder
Gallbladder


Gallbladder
Gallbladder


Bile pathway
Bile pathway


Definition:

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



Alternative Names:

Gallstone in the bile duct; Bile duct stone; Bile calculus; Biliary calculus



Causes, incidence, and risk factors:

About 15% of people with gallstones will develop stones in the common bile duct, the small tube that carries bile from the gallbladder to the intestine.

Risk factors include a previous medical history of gallstones. However, choledocholithiasis can occur in people who have had their gallbladder removed.



Symptoms:

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


Signs and tests:

Tests that show the location of stones in the bile duct include the following:

Your doctor may order the following blood tests:



Treatment:

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


Support Groups:



Expectations (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.



Complications:

Calling your health care provider:

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.



Prevention:



References:

Verma D. EUS vs MRCP for detection of choledocholithiasis. Gastrointest Endosc. 2006;64(2):248-254.

Chari RS, Shah SA. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap. 54.

Afdhal N. Diseases of the gallbladder and bile ducts. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap. 159.




Review Date: 6/3/2008
Reviewed By: Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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