Choledocholithiasis pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Adenike Eketunde
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Overview
It is thought that Choledocholithiasis is the result of gallstone produced either in the gall bladder or bile duct obstructing the common bile duct.
Pathophysiology
It is understood that the Bile is made in the liver and stored in the gallbladder. Concentrated bile from the gallbladder can lead to the formation of gallstone. The stone passes from the gallbladder to the cystic duct, then into the common bile duct (CBD), and block the CBD. [1]
Primary Choledocholithiasis is formed from stones within the bile duct that occur due to bile stasis in the CBD, forming an intraductal stone. The cause of bile duct stasis includes bile duct dilatation with increasing age. Less commonly, bile stasis can result from complications from Mirizzi Syndrome or hepatolithiasis (gallstone in the biliary duct of the liver). The obstructed flow of the bile duct leads to obstructive jaundice and possibly hepatitis. The stagnant Bile can lead to infection and inflammation of the bile duct, causing bactibilia and ascending cholangitis. If the blockage is at the common bile duct after the pancreatic duct, join the CBD, it can become inflamed, with autoactivation of pancreatic enzymes leading to gallstone pancreatitis. Choledocholithiasis can also be secondary to cholelithiasis and choledochoduodenal-fistula stricture. choledochoduodenal-fistula is an abnormal opening in choledochus and the duodenum and a rare complication of chronic duodenal ulcer with cholelithiasis. The stone formed in the gallstone and transported to the gallbladder usually pure choleterol stone, but can be pigment stones or mixed composition. The cholesterol stone is formed from supersaturation of cholesterol when there is not enough bile to saturate the choleterol in solution or impaired motility of the gallbladder. Pigment stone are formed from red blood cells breakdown.[2] [3] [4] [5]
References
- ↑ https://jamanetwork.com/journals/jama/fullarticle/2706140
- ↑ Njeze GE (2013). "Gallstones". Niger J Surg. 19 (2): 49–55. doi:10.4103/1117-6806.119236. PMC 3899548. PMID 24497751.
- ↑ https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/gallbladder-and-bile-duct-disorders/choledocholithiasis-and-cholangitis https://radiopaedia.org/articles/recurrent-pyogenic-cholangiohepatitis-1?lang=us
- ↑ B S B, Kar A, Dutta M, Mandal A, De Bakshi S (2017). "A case of choledochoduodenal fistula - an unusual case report". Clin Case Rep. 5 (9): 1462–1464. doi:10.1002/ccr3.991. PMC 5582229. PMID 28878904.
- ↑ https://journals.lww.com/ajg/Fulltext/2018/10001/Secondary_Multiple_Choledocholithiasis_in.2161.aspx?__cf_chl_jschl_tk__=8dbf6b78ccc27338b4f6be5657b6a51776ee5f37-1604332386-0-AcuXzQIt4c1HaCWBf9hSa3EHuEWWQi-LLdalnwICEz7desYL-RQVMp2l3T_TSL6XxnuG_LURfZMwYF3rNQlyCOqoSDr0QNDuEx7lh6xagxBosv92m2RHHr2CT01qFwG_Xhhpk0IJxYah9rLukVRKsAlWqBVMiWmx2lhCUGDuh47qCLnkJ4NojmmXwLgxMzQwdT3WyCIpNut7OBJB9mLOQg0eOSl_fFwVE582N78ro5yq8Wh5zRgQ5Y2Oh5KiEtFSf79dhyRgnxyrbrv1-uEj0IMJs0N12UqzOQ2uSwXuC4PXR-299SH8luxtGeIflx-bZoEk1zXoKOAkJoopLnUCBmF8MPgkj7uCrempA51vz2TL91NQ1T4L_ualXqWWt6_PWdB8jg2hVNRW0T44RWCyKhd18FOkyOVUERCGhrrHETVMHzliqZMIpsZY8IihYuG7cQ