So wo gallstones nso akɔhyɛ bile duct a ɛtaa ba no mu? (Chodocholithiasis) Momma yensua ho ade!

Ɛtɔ mmere bi a, wote ɛyaw a ano yɛ den nka wɔ wo yafunu atifi nifa so bere a woadidi awie no? So wote nka sɛ wo ho yɛ wo yaw anaasɛ wote nka sɛ wobɛfe? So ɛtɔ mmere bi a wote nka sɛ w’ani ne wo honam ani reyɛ kɔkɔɔ? Eyinom nyɛ sɛnkyerɛnne pa a ɛsɛ sɛ wobu ani gu so kɛkɛ. Eyinom betumi akyerɛ sɛ ɔbo bi akɔhyɛ wo ‘Common Bile Duct’ mu . Ɛnnɛ, yɛbɛka saa tebea yi a wɔfrɛ no ‘Choledocholithiasis’ ho asɛm.

Sɛ yɛbɛka no tiawa a, dɛn ne eyi (choledocholithiasis)?

Choledocholithiasis yɛ tebea a abo biako anaa nea ɛboro saa akɔhyɛ wo mogya ntini a ɛtaa ba no mu . "Choldocho" yɛ Latin din a wɔde frɛ bile duct a wɔtaa de di dwuma. "Lithiasis" kyerɛ ɔbo. Gallstones yɛ bile asinasin a ɛyɛ den a ɛte sɛ abotan. Saa abo yi betumi ayɛ yɛn nipadua no baabiara a bile sen fa mu.

Afei ebia woresusuw nea ɛyɛ saa bile yi ne nea ɛyɛ bile ntini no ho. Ɛyɛ mmerɛw yiye. Yɛn mmerɛbo na ɛma saa bile yi ba. Saa bile yi boa yɛn ma yɛyam aduan a yedi, titiriw srade. Saa bile yi boaboa ano wɔ akisikuru no mu. Efi hɔ no, ɛfa afiri ketewaa bi mu kɔ mogya ntini a wɔtaa de di dwuma no mu, na afei ɛka dwensɔtwaa ketewa no ho. Enti, sɛ ɔbo bi sisi baabi wɔ akwantu yi mu a, ɔhaw no ne.

Enti so (Chodocholithiasis) ne (Cholelithiasis) yɛ nneɛma abien a ɛsono emu biara?

Yiw, nsonsonoe kakra wɔ mu. Ebia woate asɛmfua ‘cholelithiasis’ no. Ɛkyerɛ sɛ abo wɔ akisikuru mu . Akisikuru betumi ayɛ wɔ akisikuru no ankasa mu, wɔ ntini a ɛma mogya tu no mu, anaa abien no nyinaa mu. Ɔbo a ɛba wɔ akisikuru mu mpo betumi akɔ akyiri yi akɔ mogya ntini a ɛtaa ba no mu.

Sɛ yɛbɛka no tiawa a, ‘Cholelithiasis’ kyerɛ akisikuru. ‘Choldocholithiasis’ kyerɛ abo (baako anaa nea ɛboro saa) a afi akisikuru mu aba na akɔhyɛ mogya ntini a ɛtaa ba no mu. Ate aseɛ?

Nsonsonoe bɛn na ɛda Choledocholithiasis ne Biliary Colic ntam?

Sɛ wowɔ choledocholithiasis a, ɛkyerɛ sɛ anyɛ yiye koraa no wowɔ ɔbo biako wɔ wo mogya ntini a ɛtaa ba no mu. Sɛ ɔbo no sua koraa a , ebia worenhyia ɔhaw biara. Ebetumi mpo afa wo dwensɔtwaa mu na afi wo nipadua mu. Nanso sɛ ɔbo no yɛ kɛse na esiw mogya ntini a ɛtaa ba no ano a, ebia wobɛte yafunu mu yaw a emu yɛ den a ɛkɔ so daa ne jaundice.

Biliary colic yɛ tebea a ɛba bere a ɔbo bi akɔhyɛ biliary nhyehyɛe no mu no. Ɛtaa ba nnipa a wɔwɔ akisikuru mu. Nanso, sɛ ɔbo bi a ɛwɔ mogya ntini a ɛtaa ba no mu no kɔhyɛ mu na esiw ntini no ano a, obi a ɔwɔ choledocholithiasis nso betumi anya biliary colic. Fa no sɛ ɔbo a ɛkyere nsuo afiri mu, ɛtɔ da bi a nsuo no sen, ɛtɔ da bi nso a ɛntene.

So eyi yɛ tebea a egye ntɛmpɛ? So mihia ayaresa ntɛm ara?

Ɛnyɛ bere nyinaa na ɔbo anaa abo a ɛwɔ mogya ntini a ɛtaa ba no mu no yɛ nea egye ntɛmpɛ. Nanso, asiane bi wɔ hɔ . Sɛnea yɛadi kan aka no, abo nketewa tumi twam fi nipadua no mu. Nanso, asiane a ɛwɔ mu ne sɛ abo no betumi akɔhyɛ hɔ, anyin kɛse bere a bere kɔ so no, na asiw kwan no ano koraa.

Esiane asiane yi nti, nnuruyɛfo taa sa abo a ɛtaa ba wɔ bile duct mu bere a wɔahu no ara pɛ. Wɔtaa kamfo kyerɛ sɛ wɔmfa endoscopy nhwehwɛ abo no mu na woyi fi hɔ. Eyi kyerɛ sɛ yafunu ne yafunu ho oduruyɛfo de afiri ketewaa bi (catheter) a wɔde hyɛ wo menewa mu di dwuma de du ntini a ɛma mogya tu no mu na woyi abo no. Mma ɛnhaw wo, wɔyɛ eyi wɔ aduru a wɔde kum nipadua no mu, enti worente nka sɛ wo ho yeraw wo kɛse.

Sɛ tebea yi (choledocholithiasis) mu yɛ den a, dɛn na ɛba?

Sɛ ɔbo bi kɔhyɛ mogya ntini a ɛtaa ba no mu na ɛma mogya a ɛsen no gyae a, ɛka mogya ntini no nyinaa. Ɛne sɛ, akwaa ne ntini afoforo a mogya fa mu no nyinaa. Eyi betumi de ɔfe, ɔyare mmoawa , ne nsɛnnennen a ɛde nkwa to asiane mu mpo aba.

Ade a ɛho hia sen biara ne sɛ wobɛhwehwɛ aduruyɛfo afotu ntɛm ara sɛ wowɔ sɛnkyerɛnne te sɛ eyinom a, a wummu w’ani ngu so.

Saa tebea yi abu so dɛn?

Sɛ wɔkyekyem pɛpɛɛpɛ a, nnipa 100 biara mu bɛyɛ 10 na wɔwɔ akisikuru. Nanso, saa abo no mu dodow no ara ba wɔ akisikuru no mu. Nnipa a wɔwɔ akisikuru mu bɛyɛ 15% nya abo wɔ mogya ntini a ɛtaa ba no mu. Nnipa dodow no ara nhyia ɔhaw biara wɔ abo yi ho da. Nnipa a wɔwɔ akisikuru mu abo bɛyɛ 20% pɛ na wonya nsɛnnennen a ɛhwehwɛ sɛ wɔsa wɔn yare.

Dɛn ne Choledocholithiasis ho sɛnkyerɛnne ahorow?

Ebia worennya yare no ho sɛnkyerɛnne biara. Sɛ abo a ɛwɔ akisikuru no nsiw wo gallbladder no kwan a, ebia wunnim mpo sɛ wowɔ bi. Nanso, sɛ worenya yare no ho sɛnkyerɛnne ahorow a, ɛkyerɛ sɛ ɔbo bi asiw wo mogya ntini a ɛtaa ba no kwan. Wɔfrɛ sɛnkyerɛnne ahorow a edi kan a ɛba bere a ntini no asiw no biliary colic. Nea ɛka ho ne:

• Yafunu mu yaw: Saa ɛyaw yi ba bere a wɔadi aduan akyi. Etumi di nnɔnhwerew biako kosi nnɔnhwerew pii. Ɛyaw no mu yɛ den wɔ simma 20 a edi kan no mu, afei nkakrankakra ano brɛ ase. Nnipa dodow no ara te nka wɔ yafunu no atifi nifa so. Nanso ɛtɔ da bi a ɛyaw no tumi trɛw kɔ nifa anaa mmati.
• Akisikuru ne ɔfe: Ɛtaa ba sɛ wobɛte akisikuru ne ɔfe a ɛne biliary colic. Nanso, wubehu sɛ, nea ɛnte sɛ atiridiinini bi no, ɛyaw no nkɔ bere a woafe awie no. Sɛ biliary colic no mu nyɛ den a, ebia wobɛte nka sɛ aduan ho akɔnnɔ ayera kɛkɛ.
• Jaundice:Sɛ bile no nsen yiye na ɛsan kɔ mogya no mu a, wo honam ani ne w’ani fitaa betumi ayɛ kɔkɔɔ. Ebia wo nsu nso bɛdan tuntum. Jaundice, te sɛ biliary colic, ba na ɛkɔ. Nanso ebetumi aba na akɔ kosi sɛ wobeyi akwanside a ɛwɔ duct no mu no afi hɔ.
• Atiridiinini: Sɛ wo ho hyehye wo kɛse wɔ biliary system no mu a, wubetumi anya atiridiinini. Atiridiinini nso betumi ayɛ ɔyare mmoawa ho sɛnkyerɛnne. Sɛ mogya ntini no siw a, mmoawa ntumi mfi nipadua no mu yiye, na ɛma ɛyɛ mmerɛw sɛ ɔyare mmoawa bɛba.

Nsɛnnennen afoforo bɛn na eyi betumi de aba?

Ɔbo bi a esiw mogya ntini a ɛtaa ba no ma mogya no san kɔ akyi. Eyi betumi aka ntini afoforo a ɛka ho, ne akwaa te sɛ akisikuru, dwensɔtwaa, ne mmerɛbo. Eyi betumi ama obi ho ayɛ hyew, anya ɔyare mmoawa, na asɛe ntini no bere tenten. Nsɛnnennen a ebetumi aba no bi ne:

• Nyarewa: Bile duct a asiw yɛ beae a ɛnyɛ den sɛ ɔyare mmoawa betumi akɔ mu. Ɔyare mmoawa a ɛwɔ biliary system no mu no yɛ asiane kɛse . Ebetumi atrɛw akɔ mmerɛbo ne mogya mu. Sɛ ɔyare mmoawa bi trɛw kɔ mogya no mu (septicemia) a, ebetumi ama obi anya tebea a emu yɛ den a ɛde ne nkwa to asiane mu (sepsis).
• Cholangitis: Ade titiriw a ɛde ɔfe ne ɔyare mmoawa ba wɔ mogya ntini a ɛtaa ba no mu ne ‘Choledocholithiasis’. Bile duct no hohoro esiane bile a ɛboaboa ano kɔ akyi nti, na bile a ɛsen no yɛ brɛoo mpo. Saa ɔfe ne ɔyare mmoawa yi betumi atrɛw afi bile ntini a ɛtaa ba no mu akɔ nkorabata afoforo mu, kyerɛ sɛ, akɔ ntini a ɛfa mmerɛbo no mu no mu. Eyi nso betumi ama mmerɛbo no ahonhon.
• Cholecystitis: Eyi yɛ akisikuru a ɛyɛ hyew. Sɛ bile san kɔ akisikuru no mu a, ɛho ahonhon. Eyi yɛ yaw. Ebetumi nso asɛe akisikuru no dwumadi na bere kɔ so no, asɛe no. Eyi ne ade titiriw a ɛde akisikuru ba.
• Gallstone Pancreatitis: Wo bile duct ne pancreas nyinaa bue kɔ dwensɔtwaa ketewa (dwensɔtwaa ketewa) no mu. Sɛ abo a ɛwɔ akisikuru mu siw kwan a ɛtaa fa so yi kwan a, dwensɔtwaa mu nsu a ɛwɔ nipadua no mu no betumi agyae kankyee. Enzyme ahorow a ano yɛ den yiye wɔ saa nsu a ɛtwetwe yi mu, na ebetumi asan akɔ dwensɔtwaa no mu, na ɛde ɔfe kɛse ne akwaa a ɛsɛe aba. Wɔfrɛ eyi dwensɔtwaa mu yare. Abo a ɛwɔ akisikuru mu ne ade titiriw a ɛde dwensɔtwaa mu yare a ɛnyɛ nsa ba.

Dɛn nti na eyi (choledocholithiasis) ba?

Yɛn mmerɛbo no fi nneɛma a ɛyi fi yɛn mogya mu no mu na ɛyɛ bile. Saa nneɛma yi bi ne srade, bilirubin, bile nkyene, ne lecithin. Gallstones ba bere a saa nneɛma yi mu biako – mpɛn pii no cholesterol, ɛtɔ mmere bi a bilirubin – bɛyɛ dodo no. Afei, saa nneɛma a ɛboro so yi boaboa ano te sɛ nsu a ɛyɛ fĩ.

Saa ade a ɛte sɛ nsu a ɛyɛ fĩ yi boaboa ano wɔ akisikuru no ase anaasɛ mogya ntini a wɔtaa de di dwuma no mu na ɛyɛ den nkakrankakra. Bere a dɔte pii sen fa so no, saa abo yi nyin nkakrankakra. Eyi betumi agye mfe pii. Abo a ɛwɔ akisikuru dodow no ara mu no ba wɔ akisikuru no mu. Afei wotu kwan fa bile duct no mu na wokowie bile duct a wɔtaa de di dwuma no mu.

Dɛn ne asiane ahorow a ɛka eyi?

Ebia ɛbɛyɛ mmerɛw sɛ wubenya abo a ɛtaa ba wɔ bile duct mu esiane nneɛma a edidi so yi nti:

• Cholangitis a enni sabea a obi wɔ: Choledocholithiasis ne ade titiriw a ɛde cholangitis ba. Nanso ebetumi asi ɔkwan foforo so nso. Sɛ wo bile ntini no ho hyew esiane biribi foforo nti a, mogya a ɛsen no betumi abrɛ ase, na ama abo ayɛ wɔ bile ntini no mu.
• Abo a ɛwɔ akisikuru mu kan: Nnipa dodow no ara a wɔwɔ akisikuru no nnya nsɛnnennen. Nanso, nnipa a wɔanya akisikuru pɛn no taa nya bi bio. Sɛ woyi wo gallbladder no sɛ aduru a wɔde sa akisikuru mpo a, wɔ tebea horow a ɛntaa nsi mu no, abo foforo betumi ayɛ wo bile ntini ahorow no mu.

Asiane afoforo a ɛtaa ma akisikuru mu abo ba no bi ne:

• Srade a Ɛkɔ Anim: Akisikuru dodow no ara (bɛyɛ 75%) fi srade a ɛboro so a ɛwɔ mogya no mu na ɛba. Wɔkyerɛ sɛ nneɛma afoforo a ɛwɔ bile mu (bile nkyene ne lecithin) no ma saa srade yi tew. Nanso sɛ ɛnkari pɛ wɔ eyinom ntam a, ɛrenyɛ adwuma yiye.
• Mmea mu nkwaadɔm: Estrogen ma mogya mu srade yɛ kɛse. Progesterone ma akisikuru a ɛtwetwe no so tew na ɛma mogya a ɛkɔ nipadua no mu no yɛ kɛse. Ɛtɔ mmere bi a, saa nkwaadɔm abien yi nyinaa kɔ soro wɔ mmea awo mfe mu. Aduru a wɔde si hormone ananmu nso betumi ama srade a ɛwɔ nipadua no mu no akɔ soro.

Ɔkwan bɛn so na wohu yare yi (choledocholithiasis)?

Wɔtaa hu abo a ɛwɔ ntini mu bere a yare no ho sɛnkyerɛnne ahorow aba akyi. Sɛ wokɔ oduruyɛfo nkyɛn kɔhwɛ yare no ho sɛnkyerɛnne te sɛ biliary colic anaa jaundice a, wo duruyɛfo bɛyɛ mogya mu nhwehwɛmu ne mfoninitwa nhwehwɛmu . Mogya mu nhwehwɛmu betumi akyerɛ sɛnea bile dodow aboaboa ano. Mfoninitwa sɔhwɛ ahorow betumi aboa ma wɔahu baabi a asiw no wɔ.

Sɔhwɛ ahorow bɛn na wɔreyɛ ama eyi?

Mogya mu nhwehwɛmu:

• Mogya dodow a wɔde ma a edi mũ (CBC) .
• Bilirubin nhwehwɛmu
• Pancreas dwumadi ho sɔhwɛ ahorow
• Mmɛn dwumadi ho nhwehwɛmu

Sɛ́ mfoninitwa sɔhwɛ ahorow no:

• Yafunu mu ultrasound:Eyi yɛ sɔhwɛ a ɛnyɛ den a ɛnyɛ yaw. Ebetumi ama woanya wo tebea no ho adwene a edi kan. Ebetumi akyerɛ sɛ abo wɔ wo gallbladder mu anaa. Ɛwom sɛ ɛnkyerɛ bile duct a ɛtaa ba no pefee de, nanso ebetumi akyerɛ sɛ duct no atrɛw anaa. Eyi kyerɛ sɛ biribi asiw kwan. Ebia nea asiw kwan no bɛyɛ te sɛ sunsuma.
• Endoscopic ultrasound: Saa sɔhwɛ yi de ultrasound mfiridwuma ne endoscopy a ɛwɔ soro bom ma ɛma mogya ntini no ho mfonini a emu da hɔ. Nea ɛka eyi ho ne sɛ wode afiri ketewaa bi a mfoninitwa afiri wom (endoscope) bɛhyɛ wo menewam na woakɔ wo yafunu ne wo dwensɔtwaa ketewaa a ɛwɔ soro no mu. Ultrasound afiri a ɛwɔ endoscope no awiei no de nnyigyei asorɔkye di dwuma de yɛ biliary nhyehyɛe no mfonini.
• MRCP (Magnetic Resonance Cholangiopancreatography): Eyi yɛ MRI (Magnetic Resonance Imaging) bi. Ɛtwa ntini a ɛwɔ mogya mu no mfonini pɔtee. Ɛnyɛ nea epira nipadua no. Ebetumi atwa biliary nhyehyɛe no nyinaa ho mfonini a emu da hɔ yiye, a bile duct a ɛtaa ba no ka ho. Oduruyɛfo no betumi adi kan ayɛ nhwehwɛmu yi sɛ osusuw sɛ ɔbo bi wɔ mogya ntini a ɛtaa ba no mu a. Nanso, sɛ ɛda adi kɛse sɛ ɔbo bi wɔ hɔ a, obetumi akɔ ERCP nkyɛn tẽẽ.
• ERCP (Endoscopic Retrograde Cholangiopancreatography): Saa nhwehwɛmu yi yɛ nea ɛyɛ hu kakra sen afoforo no. Nanso mfaso wɔ so kɛse ma abo a wɔde hwehwɛ akisikuru. Etumi yi abo nso. Ɛde X-ray ne endoscopy nyinaa na edi dwuma. Sɛ endoscope no kɔ soro wɔ dwensɔtwaa ketewa no mu pɛ a, mfiridwumayɛfo no de afiri ketewaa foforo fa mu na ɔkyerɛ no kwan kɔ bile ntini no mu. Afei, wɔde nsu soronko bi (aduru) fa afiri no mu, na wɔyɛ video X-ray (fluoroscopy) bere a aduru no fa nsukorabea ahorow no mu no. Sɛ wohu abo a, wobetumi ayɛ ho adwuma.

Ɔkwan bɛn so na nnuruyɛfo yi abo a ɛwɔ mogya ntini a ɛtaa ba no mu?

Wɔtaa yi abo yi bere a wɔreyɛ ERCP oprehyɛn no. Nnuruyɛfo betumi de nnwinnade titiriw bi a wɔde abata endoscope no awiei adi dwuma de abubu abo na wɔayi afi hɔ bere a wɔahu no. Ɛtɔ da bi a, wɔtwa ketewaa bi wɔ ntini a ɛwɔ ntini no mu (sphincterotomy) de trɛw ntini no mu na ɛma ɔbo no fa mu.

So oprehyɛn ho hia wɔ Choledocholithiasis ho?

Endoscopic retrograde cholangiopancreatography (ERCP) nhia sɛ wotwa yafunu mu na ama wɔatumi akɔ bile ntini no mu. Nanso, bere a nnuruyɛfo ayi abo afi ntini a ɛma mogya tu no mu akyi no, wɔtaa kamfo kyerɛ sɛ wɔnyɛ oprehyɛn a wɔde yi akisikuru . Nea enti a wɔyɛ eyi ne sɛ wɔremma abo mfi akisikuru no mu bio na ɛde choledocholithiasis aba.

So mehia ayaresa afoforo?

Ɛdenam wo tebea so no, ebia wubehia ayaresa afoforo ansa na wɔayi wo gallstones afi hɔ. Nhwɛsoɔ:

• Sɛ ɔyare mmoawa bi wɔ hɔ a , wɔkyerɛw nnuru a ekum ɔyare mmoawa ma .
• Akwan a wɔfa so yi biliary drainage yi bile a aboaboa ano.

Nsɛnnennen bɛn na ebetumi aba wɔ ayaresa akyi?

Nsɛnnennen a edidi so yi betumi aba wɔ bere tiaa bi mu wɔ endoscopic ɔbo a wɔayi afi hɔ akyi:

• Mogya a ɛretu
• Nsaneɛ
• Pancreatitis a ɛyɛ yare

Nea edidi so yi betumi aba wɔ bere tenten mu wɔ ayaresa akyi:

• Gallstone a ɛsan ba bio: Sɛ woyi abo a ɛwɔ bile ntini no mu nyinaa mpo a, abo foforo betumi ayɛ akyiri yi. Nnipa a wɔanya abo pɛn no taa nya bi bio.
• Bile duct fibrosis: Akuru ntini betumi ayɛ bere a wɔatwa bile duct no. Ɛtɔ mmere bi a, saa akuru yi betumi ama ntini no ayɛ teateaa (biliary stricture). Eyi betumi ama mogya ntini a ɛtaa ba no asiw ɔkwan soronko so. Ebia ebehia sɛ wɔsa no yare wɔ ɔkwan soronko so.

So wobetumi asiw choledocholithiasis a ɛba no ano?

srade a ɛwɔ wo mogya mu na ɛde abo dodow no ara ba, na wubetumi ama srade a ɛwɔ wo mogya mu no so atew denam nsakrae a wobɛyɛ wɔ w’aduan ne w’asetra kwan mu no so. Eyi betumi aboa ma asiane a ɛwɔ hɔ no so atew. Nnuruyɛfo ka sɛ kwati "yo-yo" adidi, a ɛyɛ sɛ wobɛtew wo mu duru so prɛko pɛ na afei woasan anya bio. Sɛ wo mu duru so tew a, yɛ no nkakrankakra . Sɛ wo mu duru so tew prɛko pɛ a, ɛma asiane a ɛwɔ hɔ sɛ wubenya akisikuru mu abo no yɛ kɛse.

Tebea no te dɛn wɔ ayaresa akyi?

Wɔ nnipa dodow no ara fam no, ayaresa nyɛ den na edi mu. Wɔ tebea a ɛntaa nsi a obi nya nsɛnnennen wɔ ayaresa akyi no, wobetumi asa saa nsɛnnennen no. Wɔ mfe 10 kosi 20 mu no, nnipa 100 biara mu 5 kosi 25 benya abo foforo wɔ ntini a ɛma mogya tu no mu. Sɛ wɔayi akisikuru no afi hɔ a, asiane yi sua.

Gallstone ntua betumi ayɛ osuahu a ɛyɛ yaw na ɛyɛ hu kɛse, titiriw sɛ na wunnim sɛ wowɔ abo kan a. Dodow a wonya ayaresa ntɛm no, dodow no ara na wo ho bɛtɔ wo ntɛm. Sɛ ɛba na ɛkɔ mpo a, ɛnsɛ sɛ wobu ani gu biliary colic so da. Ɛbɛkɔ so ayɛ kɛse kosi sɛ wobeyi nea asiw bile ntini no mu no afi hɔ.

Nneɛma a ɛho hia sen biara a ɛsɛ sɛ wokae (Take-Home Message) .

Okay, enti mewɔ anidaso sɛ seesei woanya ntease pa wɔ ‘choledocholithiasis’ a yɛkaa ho asɛm nnɛ no ho.

Nea ɛho hia sen biara ne sɛ, sɛ wowɔ sɛnkyerɛnne ahorow te sɛ ɛyaw a emu yɛ den wɔ wo yafunu nifa atifi, akisikuru, ɔfe, ne aniwa a ɛyɛ kɔkɔɔ a, mmu w’ani ngu so kɛkɛ na kɔ oduruyɛfo nkyɛn ntɛm ara.

Ayaresa pa wɔ hɔ a wɔde sa tebea yi. Sɛ wohu ntɛm a, wobetumi asa ansa na nsɛnnennen a emu yɛ den asɔre. Mma wo ho nnpopo, di wo duruyɛfo afotu akyi. Hwɛ w’aduan ne w’asetra kwan nso so. Afei wubetumi akɔ so anya ahobammɔ kɛse wɔ ɔhaw ahorow a ɛtete saa ho.

` Gallstones, common bile duct, choledocholithiasis, jaundice, yafunu mu yaw, endoscopy, ERCP