Choledocholithiasis is the term for the presence of stones in the bile ducts. As a rule, such obstructions form in the gallbladder. Ducts are small tubes that carry bile from the gallbladder to the intestines. The organ is a pear-shaped formation located under the liver, in the upper right corner of the abdominal cavity. Typically, stones remain in the bladder or pass freely through the common bile duct.
However, according to the results of statistical studies, it was found that about 15% of patients with gallstones also have stones in the bile ducts.
Symptoms
Choledocholithiasis is a sluggish disease that may not express itself in any way for many months and even years. However, in cases where the stone gets stuck in the duct and becomes an obstruction, the following signs of a violation occur:
- pain in the abdominal cavity, localized at the top of theright side or middle;
- increased body temperature;
- jaundice (yellowing of the skin and eyes);
- loss of appetite;
- nausea and vomiting;
- clay colored chair.
A stone in the gallbladder duct can cause both irregular and constant pain. At times, the pain seems to calm down, in order to sharply increase after a while. Acute pain syndrome can lead to the need for urgent medical attention. The most severe manifestations of the disorder are often confused with signs of cardiac disease, such as a heart attack.
Complications
A stone in the bile duct (the symptoms of which the patient ignores for a long time) can lead to infection of the biliary tract. Bacteria that multiply rapidly in the area of the lesion may move into the liver. The consequences of such an infection pose a direct threat to human life. In addition to bacterial damage, complications such as cholangiolytic cirrhosis or pancreatitis can occur.
Reasons
Two types of stones are known: cholesterol and pigment.
Cholesterol formations are yellowish in color and are the most common. Scientists believe that stones of this type gradually build up from bile, which contains:
- too much cholesterol;
- excess bilirubin;
- not enough bile s alts.
Cholesterol deposits also occur in the case ofincomplete or too rare emptying of the gallbladder.
It is still not known exactly why pigment stones form in the bile ducts. According to doctors, they are found in patients suffering from:
- cirrhosis of the liver;
- infectious diseases of the biliary tract;
- hereditary blood disorders that lead to excessive production of bilirubin by the liver.
Risk factors
The risk group primarily includes people with a history of gallstone disease and other pathologies associated with the functioning of the bile-producing organ and its associated pathways. Moreover, it is not uncommon for these patients to develop bile duct stones after bladder removal. A gallstone is sometimes enough to cause significant discomfort and severe pain.
The following factors increase the risk of deposition of cholesterol and pigment formations in the excretory tract:
- obesity;
- high-calorie, high-fat, low-fiber diet;
- pregnancy;
- long post;
- quick weight loss;
- lack of physical activity.
Some of these factors are fairly easy to fix with appropriate lifestyle changes.
Circumstances that cannot be changed include:
- age: stones are more common in older people;
- gender: women suffer from this disease more often;
- ethnicity: Asians, Mexicans and American Indians are more likely to be diagnosed with choledocholithiasis than other peoples;
- family history: according to some scientists, genetic characteristics may play a significant role in the development of predisposition to choledocholithiasis.
Diagnosis
If there are appropriate symptoms, the doctor will have to verify the presence of stones in the common bile duct. For diagnostic purposes, one of the following imaging studies is performed:
- transabdominal ultrasound - a procedure that uses high-frequency sound waves to examine the condition of the liver, gallbladder, spleen, kidneys and pancreas;
- abdominal computed tomography (cross X-ray);
- endoscopic ultrasound (an ultrasound probe is placed in a flexible endoscopic tube and passed through the mouth into the digestive tract);
- endoscopic retrograde cholangiography - a procedure that allows you to localize not only stones in the bile ducts, but also other pathological phenomena (tumors, areas of narrowing);
- magnetic resonance cholangiopancreatography - MRI of the gallbladder and pancreatic duct;
- percutaneous transhepatic cholangiogram - X-ray of the bile ducts.
Your doctor may also order one or more blood tests to make sure you have or don't have an infection and check at the same timestability of the functioning of the liver and pancreas. The most commonly prescribed examinations are:
- complete blood count;
- bilirubin test;
- analysis of pancreatic enzymes;
- analysis of the liver.
Treatment
Stones from the bile duct must be removed to ensure normal patency and the disappearance of pain. Doctors may recommend one of the following procedures to relieve the obstruction:
- extraction of stones;
- breaking cholesterol and pigment formations into fragments (lithotripsy, crushing);
- surgery to remove the gallbladder and obstruct the ducts (cholecystectomy);
- surgical operation that cuts the common bile duct to remove or facilitate the passage of stones (sphincterotomy);
- biliary stenting.
Procedures
Endoscopic biliary sphincterotomy remains the most common treatment for choledocholithiasis. During this procedure, a special device in the form of a balloon or basket is placed in the clogged bile duct. With its help, the obstruction of the paths is eliminated. This method has been proven effective in 85% of cases.
If the stone does not pass on its own and the doctor suspects that endoscopic biliary sphincterotomy will not be enough, lithotripsy is prescribed. In this procedure, stones are crushed into small fragments to make them easier to remove orsolo walkthrough.
A stone in the gallbladder duct may be adjacent to a similar formation in the organ itself. In such cases, the most effective method of treatment is the removal of the gallbladder. During surgery, the doctor will examine the duct to make sure it is normal.
If stones cannot be completely removed by surgery for any reason (or if you have long-term pain caused by stones in a blocked duct but do not wish to remove your gallbladder), your doctor will recommend biliary stenting. The procedure consists of inserting tiny tubes that widen the passage and thereby eliminate obstruction and stones in the bile duct. The operation is sparing and provides effective prevention of cases of choledocholithiasis in the future. In addition, stents can also protect against infectious diseases.
Prevention
If you have already experienced pain associated with choledocholithiasis once, most likely the pain syndrome will recur - and more than once. Even removal of the gallbladder is not the best treatment: bile duct stones must be removed purposefully, otherwise the risk of typical symptoms of the pathological condition remains.
However, in many cases choledocholithiasis can be prevented. All you need to do is make small changes to your lifestyle. The risk of the disease is significantly reduced by moderate exercise and slight changes in diet. Doctors advise walking as often as possible and making sure your diet contains plenty of plant fiber. Saturated fat intake should be reduced.
Long term forecast
In 2008, several well-known medical clinics in Canada and the United States conducted a study according to which approximately 14% of patients experience the symptoms of bile duct stones again within fifteen years after the first manifestation of a typical pain syndrome and treatment. Obviously, the removal of stones from the bile ducts is not always done with sufficient care, as there is reason to believe that recurrent disease is associated with an increase in residual cholesterol formations in size.
Folk remedies
Alternative medicine is not considered highly effective in the fight against choledocholithiasis, however, according to some experts, simple traditional medicines prepared at home can increase the flow of bile or prevent excessive production and accumulation of cholesterol.
Are you experiencing pain and suspect that it is caused by a stone in the bile duct? What to do if you can not see a doctor yet? Try one of the following folk methods.
Natural preparations
- Pour a tablespoon of apple cider vinegar into a glass of apple juice and stir. Drink every time you feel pain in the gallbladder and ducts. Meanshas an analgesic effect after 5-15 minutes.
- Add four tablespoons of lemon juice to a glass of water. Drink the mixture on an empty stomach every morning. The therapy continues for several weeks - until the stones are completely eliminated from the body.
- Boil a glass of water, add a teaspoon of crushed dried peppermint leaves, remove from heat, cover and steep for five minutes. Strain and add a teaspoon of honey. Drink mint tea warm, twice a day for 4-6 weeks, preferably between meals.
- Prepare the vegetable mix. To do this, squeeze the juice from one beetroot, one cucumber and four medium-sized carrots. Mix and drink twice a day. Follow these instructions for two weeks and you will notice how quickly your condition returns to normal.
Medicinal herbs
- Place a teaspoon of dried dandelion root powder into a glass. Pour hot water over, cover and let sit for five minutes. Strain, add some honey to improve the taste. Drink this dandelion tea two to three times a day for 1-2 weeks to dissolve duct stones after gallbladder removal.
- Healing tea can also be made from other beneficial plants. Add two teaspoons of marshmallow root and one teaspoon of holly mahonia to four glasses of water. Boil the mixture for 15 minutes, then remove from heat. Add two teaspoons of dried dandelion leaves and one teaspoon of driedpeppermint leaves, then infuse the tea for 15 minutes. Strain and drink throughout the day.
Also, the tender green dandelion leaves can be eaten directly, such as steamed or added fresh to vegetable salads.
Dandelion is contraindicated in diabetic patients.
