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Choledocholithiasis

Marie L Borum, MD, EdD, MPH and Giancarlo Colon Rosa, MD Reviewed 06/2022
 


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

  • Asymptomatic (30–50%)

  • Right upper quadrant (RUQ) pain:

    • Moderate/intense spasmodic pain, often intermittent, transient, recurrent (biliary colic)

    • May radiate to right shoulder/back, not r...

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
Fryboya B, Drabek J, Lochmannova J, et al. Cholelithiasis and choledocholithiasis in children; risk factors for development. Plos One. 2018;13(5).
2
Maple  JT, Ben-Men...

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).

  • Risk factors include female gender, age, obesity and rapid weight loss, chro...

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