What is choledochoectasia? This question worries many patients. This is a rather dangerous condition in which the formation of calculi in the gallbladder occurs. As they block the ducts, unpleasant symptoms and the development of pathological processes occur, in particular, such as pancreatitis, biliary obstruction, cholangitis.
The main danger is that at the initial stages of development, the disease does not manifest itself in any way. This makes diagnosis difficult, which threatens to cause complications.
Features of the disease
The choledochoectasia code according to ICD 10 K80 refers to a type of gallstone disease characterized by the formation of stones, which subsequently violates the normal outflow of bile. Most often, the disease develops in women. The risk of pathology increases significantly after surgery to remove the gallbladder.
The clinical picture is characterized by the occurrence of painful manifestations, fever, as well as yellowness of the skin. If treatment is not done in a timely manner, dangerous complications can arise, which in some cases result in the death of the patient.
The tactics of therapy are mainly radical, since the stones are removed by the endoscopic method or by traditional surgery.
Main types
Many are interested in what is choledochoectasia and what types of this disease exist. These include such as:
- primary - stones are formed in the bile ducts;
- secondary - calculi enter the gallbladder;
- recurrent - re-development of the disease 3-4 years after surgery;
- residual - appears 2 years after the operation and manifests itself in the form of calculi in the bile duct.
Symptoms and treatment of the disease largely depend on its type, which is why, you must first consult a doctor.
Causes of occurrence
The disease develops over a long time. Often its occurrence is associated with the formation of stones and their subsequent blockage of the ducts. The movement of calculi occurs due to a violation of the function of this organ, namely the deterioration of the contractile function and increase in pressure.
The degree of development of pathology largely depends on the size of the stone, the larger it is, the less likely it is to move into the ducts and surgery is not required. Among the causes of choledochoectasia, the following should be noted:
- chronic pancreatitis;
- cholangitis;
- trauma to the bile ducts;
- cyst;
- inflammatory processes;
- helminthiasis.
The development of the disease is based on increased pressure in the ducts. When the stone moves, severe irritation of the walls of the affected organ is observed, which subsequently threatens with inflammation. This area is becoming a very good environment for the development of pathogens.
Key features
Symptoms of choledochoectasia largely depend on the particular course of the disease. These include the following:
- an attack of biliary colic;
- cholangitis;
- jaundice;
- acute pancreatitis.
Biliary colic appears when the pressure in the gallbladder increases, the lumen is blocked by a stone, as well as its movement along the bile duct with trauma to its walls. In this case, severe pain occurs, which is cutting or stitching in nature and is localized in the right hypochondrium or region of the stomach. Sometimes soreness appears in the lower back or back.
With choledochoectasia, a significant violation of the full outflow of bile occurs, which leads to staining of the skin and sclera in a yellowish tint. In this case, the components of bile penetrate the blood, spreading gradually throughout the body and giving the skin a characteristic color.
Jaundice resulting from prolonged obstruction of the bile duct is accompanied by bleeding of stool and darkening of urine. In addition, a person may have bouts of nausea and vomiting.
If it gets into the bile ducts of an infection, inflammation begins to develop, that is, cholangitis. It is characterized by fever, severe weakness, and severe pain. The lack of timely treatment can lead to the appearance of multiple foci of suppuration in the liver, and then the development of sepsis.
Acute pancreatitis develops if the stone blocks not only the bile duct, but also the lumen of the duodenum. Usually, such inflammation is severe and often requires surgery.
It is very important for people who have been given this diagnosis to know what this choledochoectasia is and how it manifests itself in order to timely treat and prevent the transition to an advanced stage.
Diagnostics
Before treating choledochoectasia, a comprehensive diagnosis is required. It includes a number of surveys. First of all, an ultrasound examination of the liver and gall bladder, as well as liver biochemical tests, are prescribed.
If the disease is almost asymptomatic, then the patient is necessarily assigned a screening study of the biochemical composition of the blood to determine changes in phosphatase and bilirubin. However, laboratory examination does not always provide accurate data, so instrumental diagnostic techniques are prescribed.
Ultrasound will determine the presence of channel extensions, as well as blockage of bile and stones in the gallbladder. If this procedure does not provide the required information, then the patient is prescribed ERCP. A similar technique is good in that at the same time you can perform an operation and remove the stone from the bile duct.
The next way to detect a disease is cholangography. If there are complications, MRI is required. CT is used very rarely, since this procedure provides little information regarding the course of this disease.
Treatment features
Many are interested in what is choledochoectasia and how to treat this disease, as it is very complex and provokes the occurrence of dangerous side effects. In most cases, the treatment consists of removing stones from the bile ducts. During an endoscopic examination, the catheter is inserted through the sphincter, due to which the duct will expand and it will be possible to remove the calculus.
Conservative therapy during the course of this disease is prescribed very rarely, since it has the least effect. It is used only when it is impossible to carry out the operation. Also, as part of the treatment, it is imperative to follow a diet that greatly facilitates the process of conducting therapy, and also helps to avoid complications.
Drug treatment
Many are interested in what is choledochoectasia. The treatment is mainly carried out surgically, however, in some cases, medications may be prescribed. Such therapy is used in patients who suffer from not too pronounced symptoms, if the stones are small. It is possible to stabilize the patient's condition with the help of such drugs as:
- antispasmodics ("Spazmalgon", "Baralgin");
- anti-inflammatory ("Ibuprofen", "Diclofenac");
- antibiotics (penicillins, cephalosporins).
Antispasmodics help relax the muscles for the natural removal of stones through the digestive tract. Anti-inflammatory drugs can minimize the severity of the pathological process. Antibiotics eliminate pathogens. If necessary, other agents can also be prescribed, it all depends on the characteristics of the clinical manifestations.
Operation
Doctors often prescribe surgical treatment. What is choledochoectasia and how the procedure will be carried out, explain to the attending doctor after diagnosis. During the operation, it is not necessary to make a large incision on the abdomen.
In the hospital, the patient is undergoing ERCP to clarify the presence of the stone, its location and many other parameters. If the diagnosis is confirmed, then this study turns into treatment. For this, a dissection of the narrowed area is performed. The surgeon's further tactics are largely dependent on the size of the stones. If they are more than 2 cm, then they are crushed, and if less than 1 cm, then often they leave on their own within 2 days.
If it is impossible to remove the stones by the endoscopic method, then resort to laparoscopy or classical surgery. It implies the dissection of the common bile duct with a special tool and the subsequent removal of calculi. In this case, the gallbladder is removed.
After the operation, the patient should regularly undergo an examination, follow all medical recommendations regarding the diet and taking medications, which will be prescribed by the doctor in the hospital. In any case, the tactics of therapy should be determined by a specialist.
Dieting
With choledochoectasia of the gallbladder, special nutrition is prescribed. It is important to follow recommendations on it, such as:
- food should be liquid;
- you need to steam the products, boil or stew;
- food should be fractional;
- you need to adhere to the optimal drinking regimen.
From your usual diet, you must definitely exclude such products as:
- marinades, sauces, preservation;
- fatty foods with a lot of seasoning;
- fresh pastries and pastries;
- alcoholic and carbonated drinks;
- fast foods and convenience foods.
The prohibited and recommended products are determined by the doctor individually. Diet should be followed as much as required. All clinical recommendations must be followed very strictly.
Forecast
This disease is quite complex and a person can suffer from dangerous complications. With moderate choledochoectasia, the prognosis is quite favorable, especially if timely treatment is given. Without complex therapy, the patient may have obstruction, obstructive jaundice, and in some cases cirrhosis.
After surgery, approximately one in four patients has relapses. In this case, the complete removal of the gallbladder is recommended.
Possible complications
It is important not only to know what this choledochoectasia is, but also what complications may arise. In particular, there may be diseases such as:
- cholangitis;
- pancreatitis
- secondary biliary cirrhosis;
When involved in the pathological process of gallbladder diseases, a person has very severe pain in the back and lower back. In the case of joining pancreatic pathologies, severe vomiting and dehydration are observed.
Prophylaxis
As for prevention, in this case, you need to adhere to certain recommendations, in particular, such as:
- eliminate excessive consumption of alcoholic beverages;
- treat inflammatory and infectious diseases;
- eat properly and balanced;
- observe safety precautions when working with toxic substances.
Be sure to take only those medicines that the doctor prescribed. If you feel unwell, you should immediately consult a doctor, and not conduct treatment yourself.