Common bile duct stones, gallstones and obstructive jaundice
Obstructive jaundice is anything that blocks the bile duct and prevents the bilirubin and hepatic juice from reaching the intestine. The blocked canal, where the blood bilirubin mixes with other toxins, can cause dangerous complications if left untreated.
What is the cause of obstructive jaundice? There’s a number of factors, from bile duct stones and strictures (benign or malignant) to external pressure (pancreatic head cancer, hepatic mass, lymphadenopathy, periampullary carcinoma), and intestinal flukes.
Risk factors in the development of gallstones are advancing age, female gynaecological factors, obesity, genetic predisposition, rapid weight loss, cirrhosis, hemolytic anemia, hypertriglyceridemi, medication (estrogen and oral contraceptives; clofibrate; ceftriaxone; octreotide); gallbladder stasis, diabetes mellitusspinal cord injury and reduced physical activity (at least in men).
Factors that can protect against gallstones are statins (an anti-cholesterol agent), ascorbic acid (vitamin C), coffee, vegetable protein, poly and monounsaturated fat.
Symptoms differ depending on the stones’ location. A patient with uncomplicated gallstone disease typically turns up wth with biliary colic, a normal physical examination finding and normal laboratory test results; biliary colic is often associated with sweating, nausea and vomitting. Complications from gallstones can be varied: > Cholecystitis with right upper abdominal pain radiating to the back (right shoulder), vomitting and fever. > Some stones migrate from the gallbladder to the bile duct; so the patient has the same symptoms as above plus jaundice and dark urine, as the stone blocks the bile from cooling into the intestine.
> Sometimes, the stone blocked in the last part of the common bile duct can block the pancreatic duct (pancreatic duct and bile duct confluent in papilla of vater in the duodenum wall). When the pancreatic duct is blocked, the pancreatic juice returns back and ingests the pancreatic structure, causing severe pain in the upper abdominal area radiating to the back, along with vomitting and moderate fever. Treatment also varies according to the stone’s location. For Cholecystitis, the gall bladder is removed using laparoscopy. With bile duct stones, the stone is removed by endoscopic method without surgery. The endoscope is introduced orally till it reaches the second part of the duodenum, where the bile duct enters the intestine. The bile duct and stones are examined, and the stones are extracted. Big stones are broken down — using different methods like electro-hydraulic or laser probe — into small pieces and then removed.