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Choledocholithiasis

Marie L Borum, MD, EdD, MPH and Giancarlo Colon Rosa, MD Reviewed 04/2024
 


BASICS

DESCRIPTION

  • Stones in common bile duct (CBD)

  • Several types: cholesterol (majority), calcium bilirubinate or pigment, and mixed stones

  • System(s) affected: gastrointestinal; hepatobiliary

  • Synonym(s):...

DIAGNOSIS

HISTORY

  • Ask about onset, timing, and severity of abdominal pain and any previous occurrences of similar pain

  • Asymptomatic (30–50%)

  • Right upper quadrant (RUQ) pain:

    • Moderate/intense spasmodic pai...

TREATMENT

Goal is to relieve obstruction. If not symptomatic, small stones may pass spontaneously. 

MEDICATION

Antibiotics if infection is suspected—cover enteric flora 
  • Initiate broad-spectrum antibioti...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

After endoscopic bile duct clearance, patients should undergo cholecystectomy within 1 week. 

Patient Monitoring

  • Serial liver function tests and bilirubin levels, W...

REFERENCES

1
Buxbaum JL, Abbas Fehmi SM, Sultan S, et al; for ASGE Standards of Practice Committee. ASGE guideline on the role of endoscopy in the evaluation and management of choledocholithiasis. Gast...

ADDITIONAL READING

Bosley ME, Zamora IJ, Neff LP. Choledocholithiasis—a new clinical pathway. Transl Gastroenterol Hepatol. 2021;6:35. doi: 10.21037/tgh-20-172.  

SEE ALSO

  • Cholangitis, Acute; Cholecystitis; Cholelithiasis

  • Algorithm: Hyperbilirubinemia and Jaundice

CODES

ICD10

  • K80.50 Calculus of bile duct w/o cholangitis or cholecyst w/o obst

  • K80.51 Calculus of bile duct w/o cholangitis or cholecyst w obst

  • K80.40 Calculus of bile duct w cholecystitis, unsp, w/o obs...

CLINICAL PEARLS

  • Stones in the CBD are either primary (originate within the CBD) or secondary (migrate from the gallbladder).

  • Cholangiography is gold standard for diagnosis.

  • MRCP is the most accurate non...

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