Are your gallstones also stuck in the common bile duct? (Choldocholithiasis) Let's learn about it!

Do you sometimes feel a sharp pain in the upper right side of your abdomen after a meal? Do you feel nauseous or feel like vomiting? Do you sometimes feel that your eyes and skin are turning yellow? These are not good symptoms to just ignore. These could indicate that a stone is stuck in your 'Common Bile Duct' . Today, we will talk about this condition called 'Choledocholithiasis'.

Simply put, what is this (choledocholithiasis)?

Choledocholithiasis is a condition where one or more stones are stuck in your common bile duct . "Choldocho" is the Latin name for the common bile duct. "Lithiasis" means stone. Gallstones are hard, pebble-like pieces of bile. These stones can form anywhere in our body where bile flows.

Now you may be wondering what this bile is and what the bile ducts are. It's very simple. Our liver produces this bile. This bile helps us digest the food we eat, especially fats. This bile collects in the gallbladder. From there, it travels through a small tube to the common bile duct, which then joins the small intestine. So, if a stone forms somewhere along this journey, the problem is.

So are (Choldocholithiasis) and (Cholelithiasis) two different things?

Yes, there is a slight difference. You may have heard the term 'cholelithiasis'. It means having stones in the gallbladder . Gallstones can form in the gallbladder itself, in the bile ducts, or in both. Even a stone that forms in the gallbladder can later move into the common bile duct.

Simply put, 'Cholelithiasis' means gallstones. 'Choldocholithiasis' means stones (one or more) that have come out of the gallbladder and become stuck in the common bile duct. Got it?

What is the difference between Choledocholithiasis and Biliary Colic?

If you have choledocholithiasis, it means you have at least one stone in your common bile duct. If the stone is very small , you may not have any problems. It may even pass through your intestines and out of your body. But if the stone gets bigger and blocks the common bile duct, you may experience severe, persistent abdominal pain and jaundice.

Biliary colic is a condition that occurs when a stone becomes lodged in the biliary system. It is most common in people with gallstones. However, if a stone in the common bile duct becomes lodged and blocks the duct, a person with choledocholithiasis can also experience biliary colic. Think of it like a stone stuck in a water pipe, sometimes the water flows, sometimes it doesn't.

Is this an emergency? Do I need immediate treatment?

Having a stone or stones in the common bile duct is not always an emergency. However, there is a risk . As mentioned earlier, small stones can pass out of the body. However, the risk is that the stones can get stuck there, grow larger over time, and completely block the duct.

Because of this risk, doctors usually treat common bile duct stones as soon as they are found. They often recommend using an endoscopy to examine and remove the stones. This means that a gastroenterologist uses a small tube (catheter) that is inserted down your throat to reach the bile ducts and remove the stones. Don't worry, this is done under anesthesia, so you won't feel much discomfort.

What happens if this condition (choledocholithiasis) becomes severe?

If a stone gets stuck in the common bile duct and stops the flow of bile, it affects the entire biliary system. That is, all the other organs and ducts through which bile flows. This can cause inflammation, infections , and even life-threatening complications.

The most important thing is to seek medical advice immediately if you have symptoms like these, without ignoring them.

How common is this condition?

On average, about 10 out of 100 people have gallstones. However, most of those stones form in the gallbladder. About 15% of people with gallstones develop stones in the common bile duct. Most people never have any problems with these stones. Only about 20% of people with gallstones develop complications that require treatment.

What are the symptoms of Choledocholithiasis?

You may not have any symptoms. If your gallbladder is not blocked by gallstones, you may not even know you have them. However, if you are having symptoms, it means that your common bile duct is blocked by a stone. The first symptoms that occur when the duct is blocked are called biliary colic. They include:

• Stomach pain: This pain occurs after a meal. It can last from one to several hours. The pain is intense for the first 20 minutes, then gradually subsides. Most people feel it in the upper right part of the stomach. But sometimes the pain can spread to the right side or shoulder.
• Nausea and vomiting: It is common to experience nausea and vomiting with biliary colic. However, you will notice that, unlike some migraines, the pain does not go away after vomiting. If biliary colic is not severe, you may just feel a loss of appetite.
• Jaundice: When bile doesn't flow properly and backs up into the blood, your skin and the whites of your eyes may turn yellow. Your urine may also turn dark. Jaundice, like biliary colic, comes and goes. But it can come and go until the blockage in the duct is removed.
• Fever: If you have severe inflammation in the biliary system, you may develop a fever. Fever can also be a sign of an infection. When the bile ducts are blocked, bacteria cannot leave the body properly, making it easier for infections to develop.

What other complications can this cause?

A stone blocking the common bile duct causes bile to back up. This can affect other ducts connected to it, as well as organs such as the gallbladder, pancreas, and liver. This can cause inflammation, infection, and long-term tissue damage. Possible complications include:

• Infection: A blocked bile duct is an easy place for bacterial infections to enter. An infection in the biliary system is very dangerous . It can spread to the liver and blood. If an infection spreads to the blood (septicemia), it can lead to a serious, life-threatening condition (sepsis).
• Cholangitis: The main cause of inflammation and infection of the common bile duct is 'Choledocholithiasis'. The bile duct swells due to the backward accumulation of bile, and the flow of bile becomes even slower. This inflammation and infection can spread from the common bile duct to other branches, that is, to the ducts that pass through the liver. This can also cause the liver to swell.
• Cholecystitis: This is inflammation of the gallbladder. When bile backs up into the gallbladder, it becomes swollen. This is painful. It can also impair the function of the gallbladder and, over time, damage it. This is the main cause of gallbladder disease.
• Gallstone Pancreatitis: Your bile duct and pancreas both open into the small intestine (small intestine). If this common passage is blocked by gallstones, pancreatic secretions can stop moving. These secretions contain very strong enzymes, which can back up into the pancreas, causing severe inflammation and organ damage. This is called pancreatitis. Gallstones are the leading cause of non-alcoholic pancreatitis.

Why does this (choledocholithiasis) occur?

Our liver makes bile from the substances it filters from our blood. These substances include cholesterol, bilirubin, bile salts, and lecithin. Gallstones form when one of these substances – usually cholesterol, sometimes bilirubin – becomes too much. Then, these excess substances build up like sludge.

This sludge-like material collects at the bottom of the gallbladder or in the common bile duct and gradually hardens. As more sludge flows over it, these stones gradually grow larger. This can take years. Most gallstones form in the gallbladder. Then they travel down the bile duct and end up in the common bile duct.

What are the risk factors that affect this?

You may be more likely to develop common bile duct stones for the following reasons:

• Having chronic cholangitis: Choledocholithiasis is the main cause of cholangitis. But it can also happen the other way around. If your bile ducts are inflamed for another reason, the flow of bile can slow down, causing stones to form in the bile ducts.
• Previous gallstones: Most people with gallstones do not develop complications. However, people who have had gallstones before are more likely to develop them again. Even if your gallbladder is removed as a treatment for gallstones, in rare cases, new stones can form in your bile ducts.

Other risk factors that commonly contribute to the formation of gallstones include:

• High Cholesterol Levels: Most (about 75%) gallstones are formed from excess cholesterol in the blood. The other components of bile (bile salts and lecithin) are supposed to dissolve this cholesterol. But if there is an imbalance between these, it will not work properly.
• Female hormones: Estrogen increases cholesterol. Progesterone decreases gallbladder contractions and increases bile flow. Both of these hormones are sometimes elevated during women's reproductive years. Hormone replacement therapy can also increase cholesterol levels.

How is this disease (choledocholithiasis) diagnosed?

Bile duct stones are often discovered after symptoms develop. If you seek medical attention for symptoms such as biliary colic or jaundice, your doctor will do blood tests and imaging tests . Blood tests can show how much bile has accumulated. Imaging tests can help determine where the blockage is.

What tests are being done for this?

Blood tests:

• Complete blood count (CBC)
• Bilirubin test
• Pancreas function tests
• Liver function tests

As imaging tests:

• Abdominal ultrasound: This is a simple, painless test. It can give you an initial idea of ​​your condition. It can show if there are stones in the gallbladder. Although the common bile duct is not very clearly visible, it can show if the duct is dilated. This indicates that there is a blockage. The blockage may appear as a shadow.
• Endoscopic ultrasound: This test combines ultrasound technology with an upper endoscopy to produce clear images of the bile ducts. This involves inserting a small camera-equipped tube (endoscope) down your throat and into your stomach and upper small intestine. The ultrasound device at the end of the endoscope uses sound waves to create images of the biliary system.
• MRCP (Magnetic Resonance Cholangiopancreatography): This is a type of MRI (Magnetic Resonance Imaging). It specifically takes pictures of the bile ducts. It is not harmful to the body. It can take very clear pictures of the entire biliary system, including the common bile duct. The doctor may do this test first if he suspects that there is a stone in the common bile duct. However, if there is a high probability that there is a stone, he may go straight to an ERCP.
• ERCP (Endoscopic Retrograde Cholangiopancreatography): This test is a little more invasive than the others. But it is very useful for finding gallstones. It can also remove stones. It uses both X-rays and endoscopy. Once the endoscope is up in the small intestine, the technician inserts another small tube through it and guides it into the bile ducts. Then, a special liquid (dye) is injected through the tube, and video X-rays (fluoroscopy) are taken as the dye travels through the ducts. If stones are found, they can be treated.

How do doctors remove stones in the common bile duct?

These stones are often removed during an ERCP procedure. Doctors can use special instruments attached to the end of the endoscope to break up and remove stones when they are found. Sometimes, a small cut is made in the muscle of the duct (sphincterotomy) to widen the duct and allow the stone to pass through.

Is surgery necessary for Choledocholithiasis?

Endoscopic retrograde cholangiopancreatography (ERCP) does not require an abdominal incision to access the bile ducts. However, after removing stones from the bile ducts, doctors often recommend gallbladder removal surgery . The reason for this is to prevent stones from coming out of the gallbladder again and causing choledocholithiasis.

Will I need other treatments?

Depending on your condition, you may need other treatments before having your gallstones removed. For example:

• If there is an infection , antibiotics are prescribed.
• Biliary drainage methods to remove accumulated bile.

What complications can occur after treatment?

The following complications may occur in the short term after endoscopic stone removal:

• Bleeding
• Infection
• Pancreatitis

The following may occur in the long term after treatment:

• Gallstone recurrence: Even if all the stones in the bile ducts are removed, new stones can form later. People who have had stones before are more likely to develop them again.
• Bile duct fibrosis: Scar tissue can form when the bile duct is cut. Sometimes this scar tissue can cause the duct to narrow (biliary stricture). This can cause a different type of blockage in the common bile duct. It may require separate treatment.

Can the development of choledocholithiasis be prevented?

Most gallstones are caused by cholesterol, and you can lower your blood cholesterol levels by making changes to your diet and lifestyle. This can help reduce your risk. Doctors say to avoid "yo-yo" dieting, which is losing weight all at once and then gaining it back. If you lose weight, do it gradually . Losing a lot of weight all at once increases your risk of developing gallstones.

How is the situation after treatment?

For most people, treatment is simple and successful. In the rare case that someone develops complications after treatment, those complications can be treated. Over a period of 10 to 20 years, between 5 and 25 people in 100 will develop new stones in the bile ducts. This risk is lower if the gallbladder has been removed.

A gallstone attack can be a very painful and frightening experience, especially if you didn't know you had stones before. The sooner you get treatment, the sooner you'll feel better. Biliary colic, even if it comes and goes, and isn't too severe, should never be ignored. It will only get worse until the blockage in the bile duct is removed.

The most important things to remember (Take-Home Message)

Okay, so I hope you now have a better understanding of the 'choledocholithiasis' we talked about today.

The most important thing is that if you have symptoms such as severe pain in the upper right side of your abdomen, nausea, vomiting, and yellowing of the eyes, don't just ignore it and see a doctor immediately.

There are good treatments for this condition. If detected early, it can be cured before serious complications arise. Don't panic, follow your doctor's advice. Also take care of your diet and lifestyle. Then you can stay largely safe from such problems.

` Gallstones, common bile duct, choledocholithiasis, jaundice, abdominal pain, endoscopy, ERCP