What is a Choledocholithiasis?

Cholelithiasis, also known as gallstones, refers to diseases in which the biliary system includes stones in the gallbladder or bile ducts; biliary infections are a common disease. According to the site of the disease, it is divided into gallstones and bile duct stones. The formation of stones in the gallbladder can stimulate the gallbladder mucosa, which can not only cause chronic inflammation of the gallbladder, but also can cause secondary infections when the stones are embedded in the neck or gallbladder duct of the gallbladder, leading to acute inflammation of the gallbladder. Chronic stimulation of the gallbladder mucosa by stones can also lead to the occurrence of gallbladder cancer. It has been reported that the incidence of this type of gallbladder cancer can reach 1% to 2%.

Basic Information

nickname

Gallstones, gallstone disease

English name

cholelithiasis

Visiting department

General Surgery

Multiple people

More women than men

The main causes of gallstone disease may be:

1. Happy and quiet

Some people have less exercise and physical labor, and the contractility of their gallbladder muscles will inevitably decrease over time. Bile emptying will be delayed, which will easily cause cholestasis and the precipitation of cholesterol crystals, creating conditions for the formation of gallstones.

2. Obesity

I usually eat high-fat, high-sugar, high-cholesterol drinks or snacks, and obesity is an important basis for cholelithiasis.

3. Don't eat breakfast

Many people do not eat breakfast in modern times, and long-term absence of breakfast will increase the bile concentration, which is conducive to bacterial reproduction and easy to promote the formation of gallstones. If you insist on eating breakfast, you can promote some bile outflow, reduce the viscosity of bile stored overnight, and reduce the risk of gallstone disease.

4. After-meal snacks

When a person is in a tortuous position, intra-abdominal pressure increases, gastrointestinal motility is limited, which is not conducive to food digestion and bile excretion. Sitting for a long time after a meal affects the reabsorption of bile acids, causing cholesterol and bile acids in bile. The ratio is out of balance, and cholesterol is easily deposited.

5. People with cirrhosis

This is related to the reduction of estrogen inactivation function in patients with liver cirrhosis. The estrogen inactivation function in the body is reduced, and the estrogen level is higher. In addition, the cystic contraction function of the liver cirrhosis is poor, the gallbladder is empty, and the biliary vein Various factors such as varicose veins and elevated bilirubin in the blood can cause gallstones.

6. Genetic factors

Genetic factors clearly play an important role in determining the risk of cholelithiasis. Cholelithiasis occurs more often in close relatives of patients with cholesterol gallstone disease.

Gallbladder stones

Its symptoms depend on the size and location of the stones, and the presence or absence of obstruction and inflammation. Some patients with gallbladder stones are asymptomatic for life, so-called recessive stones. Large gallbladder stones can cause dyspnea, discomfort, belching, and anorexia of greasy foods. Smaller stones cause cholestasis and acute cholecystitis every time after a full meal, after eating greasy food, or after lying supine at night. Due to the contraction of the gallbladder, smaller stones may enter the common bile duct through the gallbladder and obstructive jaundice, and then some stones can be discharged from the bile duct into the duodenum, and some stones remain in the bile duct and become secondary bile duct stones. Stones can also obstruct the gallbladder duct for a long time without infection, and only form hydrocystic gallbladder. At this time, you can touch the enlarged gallbladder without obvious tenderness. Gallbladder stones usually have no special signs or mild tenderness in the right upper abdomen when they are not infected. However, when there is an acute infection, tenderness and muscle tension in the mid-upper and right upper quadrants can occur, and sometimes the enlarged and tender gallbladder can be affected.

2. Hepatobiliary stones

Hepatobiliary stones refer to stones in the intrahepatic bile duct system, so it is also called intrahepatic bile duct stones. Often combined with extrahepatic bile duct stones, but there are also simple intrahepatic bile duct stones, also known as true intrahepatic stones. In recent years, there are more and more cases of intrahepatic bile duct stones, and the classification of stones is mostly bilirubin stones. Hepatobiliary stones are mostly composed of yellow-green massive or "sandy" stones, mostly calcium bilirubin. Ascaris eggs can often be found in the calculus center, so some people think that hepatobiliary stones are caused by bile duct obstruction caused by biliary ascaris and bacterial infection.

Hepatobiliary stones are mostly left hepatic ducts, and the bile ducts at the confluence of the upper and lower left hepatic bile ducts of the liver are slightly enlarged and stones stay there. Right hepatobiliary stones are mostly found in the right posterior lobe bile duct.

The clinical features are mostly as follows:

(1) Patients are younger than patients with gallstones, and some patients are associated with congenital abnormalities of the intrahepatic bile ducts. Patients often have a history of recurrent episodes of abdominal pain, chills, fever, and jaundice since childhood.

(2) Impaired liver function, and gallbladder function may be normal. A variety of liver dysfunction can occur during recurrent episodes, and alkaline phosphatase rises during intermittent periods; chronic disease can lead to liver atrophy and liver fibrosis.

(3) Abdominal pain, jaundice, and fever are the main symptoms, but typical severe angina rarely occurs.

(4) Complications are numerous and serious. More common are suppurative intrahepatic cholangitis, liver abscess, and biliary tract bleeding.

(5) Biliography can show intrahepatic bile duct dilatation without extrahepatic bile duct dilation, and there is a small translucent in the hepatic duct.

Laboratory inspection

General biliary colic, without hematological and chemical changes. Leukocytosis and nuclear shift to the left are common in acute cholecystitis. Intermittent pancreatic duct obstruction results in increased serum amylase. Inflammation and edema of the gallbladder can press the common bile duct and increase the aminotransferase and alkaline phosphatase. Common hepatic and common bile duct inflammation is often accompanied by bilirubin.

2. Imaging examination

(1) The plain film of the abdomen is of little value. Only 13% to 17% of gallstones contain enough calcium to make the radiation impenetrable.

(2) Both the specificity and sensitivity of ultrasound are very high. Stones under ultrasound appear as high-amplitude echoes and post-acoustic shadows. Failure to find stones on ultrasound does not rule out a diagnosis of gallstones.

(3) The sensitivity and specificity of endoscopic ultrasound in the diagnosis of common bile duct stones are very high. Because it cannot depend on the size of the stones and the diameter of the bile duct, it is particularly valuable for the diagnosis of small stones in the common bile duct without expansion.

(4) Compared with CT examination and ultrasound examination, CT has no advantage in the diagnosis of gallstones. CT can show dilatation, stones, and masses in the bile ducts. In addition, if the common bile duct obstruction caused by the tumor is highly suspected, CT examination is feasible.

(5) Bile ductography If more accurate visualization of the biliary tract system is required, endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous liver cholangiopancreatography (PTC) should be performed. ERCP is more suitable for showing lower sites, while PTC shows higher sites or proximal obstruction.

(6) Magnetic resonance cholangiography (MRCP) MRCP has a specificity and sensitivity of> 95% in the diagnosis of intrabiliary diseases, bile duct dilatation, and biliary stenosis. It is a valuable method for diagnosing intrahepatic bile duct stones. MRCP is a non-invasive inspection, which avoids the risks brought by ERCP and PTC.

Diagnosis depends on clinical manifestations and imaging studies. The clinical symptoms and signs of biliary disorders are not highly specific. The patient's medical history, physical examination, and laboratory test results should be carefully analyzed. Typical biliary colic should also be confirmed by imaging studies.

There are many ways to treat cholelithiasis. Currently, there are two main methods. One is surgical treatment (including endoscopic minimally invasive treatment). The other is non-surgical therapy, that is, symptomatic treatment with traditional Chinese and western medicine.

Cholelithiasis surgery can be divided into general surgery and minimally invasive surgery.

1. General surgical treatment

For some large stones that do not work with drugs, the gallbladder can be directly removed by surgery, which can quickly eradicate the lesion, which is currently the best method. But there are some indications for surgery.

2. Minimally invasive surgery

It is only necessary to make three small incisions of 2 to 3 cm in the abdomen. The operation method is simple, the trauma is small, and the recovery is fast. However, minimally invasive surgery is difficult to remove small stones, and it can also induce stones.

The diet should follow the principles of light, high vitamins, and low fat, regular meals at three meals, strengthening fitness exercises, controlling weight, and fostering a healthy lifestyle.