Extrahepatic bile duct stones
Introduction
Introduction Extrahepatic bile duct stones can originate in the bile duct system and can also be discharged from the gallbladder to the bile duct. Most patients with bile duct stones have biliary colic after the fat meal and postural changes. This is because the stones move downward in the bile duct, stimulate bile duct spasm, and block bile flow. Abdominal pain occurs mostly under the xiphoid process and the right upper abdomen. The paroxysmal severe knife-like colic is often radiated to the back of the right back shoulder, and there are gastrointestinal symptoms such as nausea and vomiting. If the stones in the bile duct cannot be smoothly discharged into the intestine and continue to block the bile duct, it will cause inflammation in the bile duct. At the same time, the internal pressure of the bile duct is increased, and the bacteria in the biliary tract will be retrogradely spread. The pathogenic bacteria and toxins pass through the hepatic sinus to the hepatic vein, and then go retrograde into the systemic circulation to cause symptoms of systemic infection, such as chills and high fever. If the biliary tract is completely blocked by stones, acute suppurative cholangitis may occur, which is a very dangerous disease. If the treatment is not timely, it will lead to death in a short period of time. Because bile can not flow into the intestine, it will appear yellow acne after 1 to 2 days of obstruction, urine color turns yellow, and the color changes and turns white. Such obstructive jaundice, if not cured for a long time, can cause chronic cholestatic cirrhosis, and eventually portal hypertension. Colic and jaundice in many patients with extrahepatic bile duct stones often resolve within a week or so of the attack. This is because the bile ducts expand after the stones block the bile ducts, allowing the embolized stones to loosen or drain into the intestines. However, if the internal causes of the patient's stones are not completely solved, such as biliary tract infection, biliary stricture, biliary malformation, etc., the symptoms still recur in the near future. The patient's xiphoid and right upper abdomen are deeply tender, and sometimes the upper right abdomen also touches the enlarged gallbladder.
Cause
Cause
Extrahepatic bile duct stones can originate in the bile duct system, also known as primary bile duct stones; lesions can also be derived from the decline of stones in the gallbladder, also known as secondary bile duct stones. Primary bile duct stones account for about 50% of all cholelithiasis, more common in young adults.
Examine
an examination
Related inspection
Oral choledochoscopy venous cholangiography
Typical symptoms of extrahepatic bile duct stones are abdominal pain, chills and fever, and jaundice, which is called the trilogy of Charcoal.
(1) Abdominal pain: paroxysmal cramps in the right upper abdomen or xiphoid, radiating to the right shoulder and back. With nausea and vomiting. Often induced by eating greasy and body position changes.
(2) chills and high fever: 2/3, which occurs after abdominal pain, and is related to biliary infection, toxins or bacteria into the blood.
(3) Astragalus: jaundice occurs 1 to 2 days after abdominal pain and chills.
(4) In severe cases, there is a change in consciousness or shock, which is an acute obstructive cholangitis or severe cholangitis. Emergency surgery is required.
(5) Check the body under the xiphoid, right upper abdomen tenderness, pain in the liver area. Sometimes the enlarged gallbladder can be reached.
(6) B-ultrasound, CT showed common hepatic duct or common bile duct stones, and liver function showed an increase in direct bilirubin.
Diagnosis
Differential diagnosis
Although intrahepatic bile duct stones are part of primary bile duct stones, they have their specificity. If they coexist with extrahepatic bile duct stones, they are often similar to the clinical manifestations of extrahepatic bile duct stones. Because the intrahepatic bile duct is deeply hidden in the liver tissue, its branch and anatomical structure are complex, the location, quantity and size of the stone are uncertain. The diagnosis and treatment are far more difficult than the extrahepatic bile duct stones. It is still difficult to treat the hepatobiliary system and the effect is not satisfactory. The disease.
Typical symptoms of extrahepatic bile duct stones are abdominal pain, chills and fever, and jaundice, which is called the trilogy of Charcoal.
(1) Abdominal pain: paroxysmal cramps in the right upper abdomen or xiphoid, radiating to the right shoulder and back. With nausea and vomiting. Often induced by eating greasy and body position changes.
(2) chills and high fever: 2/3, which occurs after abdominal pain, and is related to biliary infection, toxins or bacteria into the blood.
(3) Astragalus: jaundice occurs 1 to 2 days after abdominal pain and chills.
(4) In severe cases, there is a change in consciousness or shock, which is an acute obstructive cholangitis or severe cholangitis. Emergency surgery is required.
(5) Check the body under the xiphoid, right upper abdomen tenderness, pain in the liver area. Sometimes the enlarged gallbladder can be reached.
(6) B-ultrasound, CT showed common hepatic duct or common bile duct stones, and liver function showed an increase in direct bilirubin.
