Skip to Main Content

+

  • • Cholesterol stone risk factors include:

    • -Female gender

      -Age

      -Obesity

      -Estrogen exposure

      -Fatty diet

      -Rapid weight loss

    • Complicated gallstone disease affects < 0.5% annually of patients who are asymptomatic

++

Epidemiology

+

  • • Average age generally 10 years older than those affected by cholelithiasis (eg, 40-50 years of age)

++

Symptoms and Signs

+

  • • Right upper quadrant pain

    • Painless jaundice

    • Both pain and jaundice

    • Fever

    • Asymptomatic

    • Nausea

    • Vomiting

    • Anorexia

++

Laboratory Findings

+

  • • Conjugated hyperbilirubinemia (for choledocholithiasis)

    • Elevated alkaline phosphatase (for choledocholithiasis)

    • Leukocytosis (for pancreatitis or cholangitis)

++

Imaging Findings

+

  • • Right upper quadrant US showing presence of gallstones, dilated common bile duct (CBD) (> 6 mm) and CBD stone in only 20-30% of patients with choledocholithiasis

    • ERCP showing dilated CBD and presence of single or multiple CBD stones in patients with choledocholithiasis

    • ERCP showing impacted ampullary gallstone in < 10 % of patients with gallstone pancreatitis

+

  • • Presence of signs or symptoms suggestive of cholangitis

++

Rule Out

+

  • • Biliary stricture

+

  • • History and physical exam

    • CBC

    • Liver function tests

    • Amylase and lipase

    • Right upper quadrant US

    • ERCP or laparoscopic cholangiogram

++

Surgery

+

  • • ERCP with sphincterotomy and stone extraction followed by laparoscopic cholecystectomy (preferred when cholangitis present or if pancreatitis does not resolve)

    • Laparoscopic cholecystectomy with CBD exploration

    • Laparoscopic cholecystectomy and cholangiogram followed by ERCP and stone extraction (preferred stone extraction technique is center specific for stones noted on screening cholangiogram following resolution of gallstone pancreatitis)

    • Percutaneous transhepatic cholangiography and stone extraction if ERCP unsuccessful and cholangitis present

++

Indications

+

  • • Choledocholithiasis noted to be symptomatic or asymptomatic

    • Gallstone pancreatitis

++

Medications

+

  • • Antibiotics to cover GI flora for cases of cholangitis

++

Complications

+

  • • Pancreatitis (for ERCP)

    • Bile duct injury or leak

++

Prognosis

+

  • • Gallstone pancreatitis resolves in > 90% of cases

++

Prevention

+

  • • Treatment of symptomatic cholelithiasis

++

References

Binmoeller KF, Schafer TW. Endoscopic management of bile duct stones. J Clin Gastroenterol. 2001;32:106.  [PubMed: 11205644]
Beckingham IJ: ABC of diseases of liver, pancreas, and biliary system. Gallstone disease. BMJ 2001;322:91.  [PubMed: 11154626]

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.