CHOLEDOCHOLITHIASIS

Choledocholithiasis

1. Definition: Choledocholithiasis refers to the presence of gallstones within the bile ducts.

2. Primary vs Secondary Stones:

   • Primary stones form in the bile ducts and are usually cholesterol stones.
   • Secondary stones form in the gallbladder and then migrate to the bile ducts.

3. Aetiology and Risk Factors:

   • Gallstones: The most common cause of choledocholithiasis.
   • Infections: Bacterial infections can lead to the formation of stones in the bile ducts.
   • Bile stasis: A condition where bile flow is reduced or blocked, leading to the formation of stones.

4. Clinical Features:

   • Biliary colic: Severe abdominal pain that radiates to the back.
   • Jaundice: Yellowing of the skin and whites of the eyes due to bile duct obstruction.
   • Fever: Often accompanied by chills and vomiting. Charcot’s triad: A combination of jaundice, fever, and abdominal pain, which is a classic symptom of choledocholithiasis.

5. Diagnostic Approach:

   • Lab tests: Liver function tests (LFTs) to assess liver damage and bile duct obstruction.
   • Ultrasound: To visualize the bile ducts and gallbladder.
   • Advanced imaging: Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) to visualize the bile ducts and diagnose choledocholithiasis.

6. Complications:

   • Cholangitis: Infection of the bile ducts, which can be life-threatening.
   • Pancreatitis: Inflammation of the pancreas due to bile duct obstruction.
   • Biliary cirrhosis: Scarring of the liver due to chronic bile duct obstruction.
   • Malignancy: Gallstones can increase the risk of developing gallbladder cancer.

7. Treatment:

   • Endoscopic retrograde cholangiopancreatography (ERCP): A procedure to remove stones from the bile ducts.
   • Laparoscopic cholecystectomy: Surgical removal of the gallbladder.
   • Open cholecystectomy: Surgical removal of the gallbladder through an open incision.
   • Choledocholithotomy: Surgical removal of stones from the bile ducts.

8. Homoeopathic Therapeutic Medicines:

   • Lycopodium: For symptoms of jaundice and itching.
   • Chelidonium: For symptoms of gallbladder obstruction and jaundice.
   • Nux vomica: For symptoms of gallbladder colic and abdominal pain.
   • Bryonia: For symptoms of abdominal pain and fever.