Common bile duct stones

Introduction Most common bile duct stones are located in the middle and lower segments of the common bile duct. However, as the stones increase, increase and the common bile duct expands, stones accumulate or move up and down, often the hepatic duct is involved. The meaning of common bile duct stones should actually include the entire extrahepatic bile duct stones including the common hepatic duct. The source of common bile duct stones is divided into primary and secondary. Primary choledocholithiasis is a component of primary bile duct stones that can form in the common bile duct, or stones that originate in the intrahepatic bile duct fall into the common bile duct. Secondary choledocholithiasis refers to the stones that originate in the gallbladder descending through the cystic duct to the common bile duct.

Cause

The current research results suggest that the formation of this stone is closely related to biliary tract infection, biliary stasis, and biliary parasitic diseases. The appearance of the stones is mostly brownish black, soft, brittle, different in shape, different in size and number. Some are like fine sand or unformed mud, so they are called "sand-like stones". The composition of this stone is a pigmented stone mainly composed of bilirubin calcium. The main components are bilirubin, biliverdin and a small amount of cholesterol and minerals such as calcium, sodium, potassium, phosphorus and magnesium and various trace elements. It has the highest calcium ion content in minerals and is easily combined with bilirubin to form bilirubin calcium. In addition, a variety of proteins and mucins are formed to form a mesh scaffold. Some under the microscope can see the skin of the parasite's shell, eggs and bacteria.

an examination

1. In the medical history, there are recurrent episodes of xiphoid or right upper quadrant colic, with symptoms such as nausea and vomiting, chills and fever, and jaundice.

2. There are different degrees of skin, sclera yellow staining, more under the xiphoid or right upper abdomen tenderness, muscle tension, may have gallbladder enlargement, hepatomegaly and tenderness.

3. The white blood cell and neutrophil counts increased, and the nucleus shifted to the left. There may be test results of obstructive jaundice, blood bilirubin quantification (especially direct response bilirubin) increased and often fluctuated, liver and kidney function have different degrees of damage. Elderly patients with anemia have anemia, hypoproteinemia and so on. Urinary bilirubin is elevated in urinary tribilis.

4. Intravenous cholangiography, PTC (percutaneous transhepatic cholangiography), ERCP, CT and other examinations, showing bile duct dilatation, with stone shadow. There may be partial obstruction of the lower part of the common bile duct and signs of emptying.

5. B-ultrasound indicates that the common bile duct is dilated and there are stones in the bile duct.

6. Radionuclide scan can show biliary stricture, dilatation and obstruction, which can help diagnosis.

Differential diagnosis

1. Infectious hepatitis: The patient has a history of exposure to infection. In the presence of abdominal pain and jaundice, there are often obvious precursor symptoms such as general malaise and loss of appetite. The abdominal pain is dull pain in the liver area. The jaundice appears rapidly and fades slowly, and the degree is shallow. The Fan Dengbai test shows a biphasic reaction. Patients with this disease have elevated body temperature at the beginning of the onset, but the increase and decrease of white blood cells, and lymphocytes often increase. The liver function test showed significant decline at the beginning of the lesion, which was quite prominent.

2. Biliary tsutsugamushi disease: patients are generally younger. More than 30 years old. Sudden onset, severe cramps, increased paroxysmal and a special sense of drilling. It is often accompanied by nausea and vomiting, often with mites. Astragalus is generally not obvious, unless it is late in the course of the disease, usually there is no chills. Abdominal tonic and abdominal wall tenderness are also not significant.

3. Pancreatic cancer: patients are generally older, mostly over 50 years old. The onset of concealment often precedes jaundice and is accompanied by abdominal pain (in the past, there was no similar history of abdominal pain and jaundice). Astragalus is progressive and can develop to a deep degree without fluctuations. The stool is always gray-white after lack of bile, and the urine urinary bilirubin is often negative, because the obstruction is often complete. Abdominal pain is not common, and those with abdominal pain are mostly persistent pain in the upper abdomen, often involving the back.

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