Choledocholithiasis

| Definition

• Gallstone lodged in the common bile duct (CBD)

Epidemiology

• Occurs in 1S% of Pts with gallstones

Clinical manifestations

• Biliary pain. RUQ epigastric pain, jaundice, pruritis. nausea Diagnostic studies

• Labs: T bilirubin. A$; transient spike in ALT or amylase suggests passage of stone

• RUQ U S: CBD stones seen 50% of cases; usually inferred from dilated CBD (>6 mm)

• ERCP preferred dx modality; cholangiogram (percutaneous, operative) when ERCP

unavailable or unsuccessful; EUS MRCP to exclude CBD stones when suspicion low

Treatment

• ERCP and papillotomy with stone extraction

Complications

• Cholangitis

• Pancreatitis

• Cholecystitis

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