Choledocholithiasis is a term for the presence of stones in the bile ducts. Typically, such obstruction forms in the gallbladder. Ducts are small tubes through which bile flows from the gallbladder to the intestines. An organ is a pear-shaped formation located under the liver in the upper right corner of the abdominal cavity. As a rule, stones remain in the bladder or freely pass through the common bile duct.
Nevertheless, according to the results of statistical studies, it was found that about 15% of patients with gallstones have stones in the bile ducts.
Symptoms
Choledocholithiasis is a sluggish disease that may not express itself for many months or even years. However, in cases where the stone gets stuck in the duct and turns into obstruction, the following signs of violation occur:
- pain in the abdominal cavity, localized at the top in the right side or in the middle;
- increase in body temperature;
- jaundice (yellowing of the skin and eyes);
- loss of appetite;
- nausea and vomiting;
- clay color chair.
A stone in the duct of the gallbladder can cause both irregular and constant pain. At times, the pain seems to calm down, so that after a certain interval it intensifies sharply. Acute pain can lead to the need for urgent medical attention. The most severe manifestations of the disorder are often confused with signs of a cardiological pathology - for example, a heart attack.
Complications
A stone in the bile duct (the presence of which the patient has been ignoring for a long time) can lead to infection of the biliary tract. Bacteria that multiply rapidly in the area of the lesion can move inside 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 of the liver or pancreatitis can also occur.
Causes
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 salts.
Cholesterol deposits also occur in the case of incomplete or too rare emptying of the gallbladder.
It is still not known exactly why pigment stones are formed in the bile ducts. According to the observations of doctors, they are found in patients suffering from:
- cirrhosis of the liver;
- infectious diseases of the biliary tract;
- hereditary blood diseases leading 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, in such patients stones in the bile ducts are often found after removal of the bladder. 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 diet with excessive fat and low fiber saturation;
- pregnancy;
- long post;
- rapid weight loss;
- lack of physical activity.
Some of these factors are fairly easy to fix by making appropriate changes to your lifestyle.
Circumstances that cannot be changed include:
- age: stones are more often found in people of advanced age;
- gender: women suffer from this disease more often;
- nationality: Asians, Mexicans and American Indians, choledocholithiasis is diagnosed more often than representatives of other peoples;
- family history: according to some scientists, genetic characteristics can play a significant role in the development of a predisposition to choledocholithiasis.
Diagnostics
If there are appropriate symptoms, the doctor will need to verify the presence of stones in the common bile duct. For diagnostic purposes, one of the following imaging studies is performed:
- transabdominal ultrasound is a procedure in which high-frequency sound waves are used to study the condition of the liver, gall bladder, spleen, kidneys and pancreas;
- computed tomography of the abdominal cavity (cross-ray x-ray);
- endoscopic ultrasound (an ultrasound probe is placed in a flexible endoscopic tube and is carried out through the oral cavity 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, narrowing sites);
- magnetic resonance cholangiopancreatography - MRI of the gallbladder and pancreatic duct;
- percutaneous transhepatic cholangiogram - radiography of the bile ducts.
The doctor may also prescribe one or more blood tests to verify the presence or absence of an infectious infection and at the same time to check the stable functioning of the liver and pancreas. Most often, the following examinations are prescribed:
- general blood analysis;
- bilirubin test;
- pancreatic enzyme analysis;
- analysis of the liver.
Treatment
Stones from the bile duct must be removed to ensure normal patency and the disappearance of pain. In order to eliminate obstruction, doctors may recommend one of the following procedures:
- stone extraction;
- breakdown of cholesterol and pigment formations into fragments (lithotripsy, crushing);
- surgery to remove the gallbladder and duct obstruction (cholecystectomy);
- a surgical operation consisting in the dissection of the common bile duct to remove stones or facilitate their passage (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 blocked bile duct. With its help, obstruction of the paths is eliminated. This method is proven to be effective in 85% of cases.
If the stone does not come out 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 in order to facilitate their extraction or independent passage.
A stone in the duct of the gallbladder can be adjacent to a similar formation in the organ itself. In such cases, the removal of the gallbladder is considered the most effective treatment. During the surgery, the doctor will examine the duct to make sure that it is passable.
If for some reason the stones cannot be removed completely by the surgical method (and also if you have long been suffering from pain caused by stones in a blocked duct but do not want to remove the gall bladder), the doctor will recommend biliary stenting. The procedure consists of installing tiny tubes that widen the passage and thereby eliminate obstruction and stones in the bile duct. The operation is gentle and provides effective prevention of cases of choledocholithiasis in the future. In addition, stents can protect against infectious diseases.
Prevention
If once you have experienced pain associated with choledocholithiasis, most likely, the pain will recur - and more than once. Even removal of the gallbladder is not the best treatment: stones from the bile duct must be eliminated purposefully, otherwise the risk of manifesting typical symptoms of the pathological condition will remain.
However, in many cases, choledocholithiasis can be prevented. To do this, it is enough to make small changes in your lifestyle. The risk of the disease is significantly reduced by moderate physical activity and mild changes in diet. Doctors advise to take walks as often as possible and make sure that fiber is present in large quantities in your diet. It is advisable to reduce saturated fat intake.
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 relive symptoms of bile duct stones within fifteen years after the first manifestation of a typical pain syndrome and appropriate treatment. Obviously, the removal of stones from the bile ducts is not always done with sufficient care, since there is reason to believe that a recurring disease is associated with an increase in residual cholesterol formations in size.
Folk remedies
Alternative medicine is not considered a highly effective means of combating choledocholithiasis, however, according to some experts, simple folk medicines, prepared at home, can increase bile flow or prevent excessive production and accumulation of cholesterol.
Do you feel pain and suspect that its cause is a stone in the bile duct? What to do if you see a doctor while there is no possibility? Try one of the following folk methods.
Natural preparations
- Pour a tablespoon of apple cider vinegar into a glass of apple juice and mix. Drink every time you feel pain in the gallbladder and ducts. The tool has 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. Therapy lasts several weeks - until the stones are completely eliminated from the body.
- Boil a glass of water, add a teaspoon of chopped dried peppermint leaves, remove from heat, cover and insist 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 beet, one cucumber and four medium-sized carrots. Mix and drink twice a day. Follow these directions for two weeks and you will notice how quickly your condition returns to normal.
Medicinal herbs
- Place a teaspoon of dried dandelion root powder in a glass. Pour in hot water, cover and leave for five minutes. Strain, add a little honey to improve the taste. Drink such tea from dandelion two to three times a day for 1-2 weeks to dissolve the stones in the ducts after removing the gallbladder.
- Healing tea can also be made from other healthy plants. Add two teaspoons of the Althaea officinalis root and one teaspoon of the holly magonia 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 dried peppermint leaves, then leave the tea for 15 minutes. Strain and drink throughout the day.
In addition, the delicate green leaves of dandelion can be eaten directly in food - for example, steamed or added fresh to vegetable salads.
Dandelion is contraindicated in patients with diagnosed diabetes.