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Topic: Choledocholithiasis

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	Gastroenterology Grand Rounds
		Choledocholithiasis requiring therapeutic intervention during pregnancy is rare, estimated at one in 1200 deliveries (2).
		However, choledocholithiasis may lead to cholangitis and/or gallstone pancreatitis, both of which can be detrimental to the health of both the mother and the fetus.
		Indications were gallstone pancreatitis in 6 patients, choledocholithiasis on ultrasound in 5, elevated liver enzymes and a dilated common bile duct on ultrasound in 2, abdominal pain and gallstones in one patient, and chronic pancreatitis with intractable pain and a pseudocyst on magnetic resonance imaging in one.
	www.bcm.edu /gastro/DDC/grandrounds/BCM/4-14-05/09-DISC.HTM (1334 words)

	Gallstones: Free Medical and Health Information on Gallstones Research and Treatment
		Chronic pancreatitis was diagnosed in 63 (6.1%), cholecystolithiasis and choledocholithiasis in 549 (53.5%), stones in residual biliary duct in 249 (24.3%), stenosing papillitis in 228 (22.2%).
		RESULTS: Of the 798 patients with choledocholithiasis, 764 (93.5%) had successful stone clearance, 215 (94.3%) out of 228 cases of stenosing papillitis were cured totally, while 63 had chronic pancreatitis developed from stenosing papillitis, 57 (90.1%) had sound remission of symptoms, though membranous stenosis emerged in 13 of 57 which was treated with balloon dilatation.
		INTERVENTIONS: Cholecystectomy; intraoperative cholangiography for suspected choledocholithiasis: hyperbilirubinemia, gallstone pancreatitis, and ultrasonographic evidence of common bile duct dilation or common bile duct stones; and postoperative ERCP for symptomatic choledocholithiasis: pain and jaundice.
	www.lifestages.com /health/gallston.html (16205 words)

	JPMA ::: (Site not responding. Last check: 2007-10-10)
		Criteria for choledocholithiasis greater than 3mm diameter were: visualization of stones on ultrasound and/or CT or ERCP or on intraoperative cholangiography with extraction.
		Of the 32 cases without choledocholithiasis, MRCP made the false diagnosis of choledocholithiasis in only one case for which final diagnosis was common bile duct adenocarcinoma confirmed at surgery.
		Bile duct obstruction and choledocholithiasis: Diagnosis with MR cholangiography.
	jpma.org.pk /jpma/3mar04/fulltext7.htm (2397 words)

	VHJOE - Role of EUS in Common Bile Duct Stones Prior... (Site not responding. Last check: 2007-10-10)
		Choledocholithiasis is easily identified as curvilinear hyper echoic foci with strong acoustic shadowing using either standard or catheter based EUS (1).
		Choledocholithiasis can occur as migrant from the gallbladder or forms de novo in the common bile duct (CBD).
		Endoscopic ultrasonography versus cholangiography for the diagnosis of choledocholithiasis.
	www.vhjoe.org /Volume3Issue2/3-2-3.htm (2061 words)

	Management of bile duct stones
		We conclude that the management of choledocholithiasis is in evolution, and early results suggest that laparoscopic CBD exploration compares favourably with established open surgical and endoscopic methods.
		During the early phase of laparoscopic cholecystectomy, intra-operative cholangiography was infrequently performed, and pre-operative diagnostic and therapeutic ERCP became the standard for patients suspected of harbouring a biliary duct stone.
		The presence of choledocholithiasis is confirmed, and the number and position of the calculi noted.
	ourworld.compuserve.com /homepages/l_lindsey/4260007.htm (3245 words)

	eMedicine - Choledocholithiasis : Article Excerpt by: Imad S Dandan, MD (Site not responding. Last check: 2007-10-10)
		Choledocholithiasis complicates the workup and management of cholelithiasis, necessitates additional diagnostic and therapeutic procedures, and adds to the morbidity and mortality of gallstone disease.
		Management of choledocholithiasis has been the subject of much debate over the past several years, especially with the advent of new laparoscopic techniques and greater experience with endoscopic procedures.
		Pathophysiology: Choledocholithiasis occurs as a result of either the primary formation of stones in the common bile duct (CBD) or the passage of gallstones from the gallbladder through the cystic duct into the CBD.
	www.emedicine.com /med/byname/choledocholithiasis.htm (411 words)

	Gallstones
		It is commonly associated with choledocholithiasis (calculi in the common bile duct) and may follow percutaneous (performed through the skin) transhepatic cholangiography (radiography of the bile ducts).
		Choledocholithiasis: occurs when gallstones passed out of the gallbladder lodge in the common bile duct, causing partial or complete biliary obstruction.
		A nonsurgical treatment for choledocholithiasis involves insertion of a flexible catheter, formed around a T tube, through the sinus tract into the common bile duct.
	www.med-help.net /Gallstones.html (574 words)

	Management of Gallstones and Their Complications - March 15, 2000 - American Academy of Family Physicians
		Common bile duct stones (choledocholithiasis) may form de novo in bile ducts (primary, 5 percent of common bile duct stones) or migrate to the common bile duct from the gallbladder (secondary, 95 percent of common bile duct stones).
		Composition of gallstones in the common bile duct is usually the same as that of gallstones in the gallbladder, although some bile duct stones are softer and more brownish because of deposition of calcium bilirubinate and other calcium salts caused by the bacterial deconjugation of bilirubin and hydrolysis of phospholipids.
		Ultrasonography is less sensitive for the diagnosis of choledocholithiasis and may document only one half of common bile duct stones.
	www.aafp.org /afp/20000315/1673.html (3365 words)

	eMedicine - Choledocholithiasis : Article by Imad S Dandan, MD (Site not responding. Last check: 2007-10-10)
		PTC may be the modality of choice in patients in whom ERCP is difficult (eg, those with previous gastric surgery or distal obstructing CBD stone or the lack of an experienced endoscopist) and in patients with extensive intrahepatic stone disease and cholangiohepatitis.
		Once the presence of choledocholithiasis is confirmed (initial or retained stones), therapeutic options depend on the size and location of the stone(s).
		Two issues must be addressed in the surgical treatment of choledocholithiasis, (1) the exploration of the CBD and (2) the fate of the gallbladder.
	www.emedicine.com /med/topic350.htm (7165 words)

	Lifespan's A - Z Health Information Library - Choledocholithiasis (Site not responding. Last check: 2007-10-10)
		Choledocholithiasis is the presence of a gallstone in the common bile duct.
		The stone may consist of bile pigments and/or calcium and cholesterol salts that are formed in the biliary tract.
		Call for an appointment with your health care provider if abdominal pain with or without fever develops that is not attributable to other causes, if jaundice develops, or if other symptoms suggestive of choledocholithiasis occur.
	www.lifespan.org /adam/healthillustratedencyclopedia/1/000274.html (431 words)

	American Society for Gastrointestinal Endoscopy :: Member Site (Site not responding. Last check: 2007-10-10)
		Individuals with choledocholithiasis (common bile duct stones or CDL) can present with biliary colic, nonspecific abdominal pain, obstructive jaundice, cholangitis, or acute biliary pancreatitis.
		Choledocholithiasis cannot reliably be diagnosed on the basis of the patient's history and physical examination alone.
		Choledocholithiasis in patients with normal serum liver enzymes.
	www.asge.org /nspages/practice/patientcare/choledo.cfm (1243 words)

	Choledocholithiasis (Site not responding. Last check: 2007-10-10)
		Injection of the common bile duct during the procedure showed a filling defect (arrow) corresponding to the calculus in the distal common bile duct.
		Choledocholithiasis results from a gallstone that enters the common bile duct from the cystic duct or by erosion.
		Choledocholithiasis in patients who have undergone cholecystectomy usually represents retained stones that were not identified at the time of surgery.
	www.brighamrad.harvard.edu /Cases/bwh/hcache/99/full.html (337 words)

	ASSESSMENT OF INDICATORS FOR PREDICTING CHOLEDOCHOLITHIASIS BEFORE LAPAROSCOPIC CHOLECYSTECTOMY
		The laparoscopic exploration of choledocholithiasis, although available, is limited to a few centers, due to limited experience with this demanding technique.
		Associated choledocholithiasis is present in 10%-15% of patients undergoing cholecystectomy.
		The management of choledocholithiasis during laparoscopic cholecystectomy by sphincter dilatation: initial experience in ten cases.
	www.kfshrc.edu.sa /annals/186/98-080.html (1824 words)

	Contrast-Enhanced Helical CT of Choledocholithiasis -- Miller et al. 181 (1): 125 -- American Journal of Roentgenology
		Choledocholithiasis is a common problem seen in as many as 6–12%
		On contrast-enhanced helical CT scan, choledocholithiasis is represented as central density (arrowhead) surrounded by hypoattenuating ampulla of Vater (arrow).
		Accuracy of MDCT in the diagnosis of choledocholithiasis.
	www.ajronline.org /cgi/content/full/181/1/125 (2027 words)

	eMedicine - Cholelithiasis : Article by Faye Maryann Lee, MD
		The spectrum of gallbladder disease ranges from asymptomatic cholelithiasis to gallbladder (or biliary) colic, cholecystitis, choledocholithiasis, and cholangitis.
		Choledocholithiasis is the presence of a stone in the common bile duct.
		History: The clinical stages of cholelithiasis are asymptomatic (the presence of gallstones without symptoms), symptomatic (biliary colic), and complicated (eg, cholecystitis, choledocholithiasis, cholangitis).
	www.medscape.com /files/emedicine/topic97.htm (3198 words)

	BioMed Central \| Full text \| MRCP compared to diagnostic ERCP for diagnosis when biliary obstruction is suspected: a ...
		Three of the 18 studies reporting choledocholithiasis were excluded from the analysis due to lack of data, or differences in study design.
		Since the most common cause of biliary obstruction is choledocholithiasis, we have concentrated mainly on the diagnosis of this condition.
		Sensitivities and specificities along with 95% CI for these estimates for the 15 choledocholithiasis studies are presented in Figures 3 and 4.
	www.biomedcentral.com /1471-2342/6/9 (4228 words)

	Emergency Medicine
		The authors provide an update on the diagnosis and management of choledocholithiasis, focusing on the latest treatment options and the role of new imaging techniques.
		All patients in whom choledocholithiasis is suspected should have a thorough history, physical examination, and serum chemistry evaluation.
		Even if stones are not detected by ultrasound, a dilated CBD may be found, which is suggestive of choledocholithiasis in the appropriate clinical context.
	www.emedmag.com /html/pre/gic/consults/101502.asp (2306 words)

	UpToDate Endoscopic ultrasonography in patients with suspected choledocholithiasis
		— Choledocholithiasis (common bile duct stones) develops in up to 20 percent of patients with gallbladder stones [1].
		The sensitivity increases with the serum bilirubin concentration and the duration of jaundice [7].
		Ultrasound has similar sensitivity to CT for detecting choledocholithiasis (75 percent in the presence of dilated ducts, 50 percent for nondilated ducts).
	patients.uptodate.com /topic.asp?file=gi_endos/4667 (440 words)

	Choledocholithiasis - Wikipedia, the free encyclopedia
		Choledocholithiasis is the presence of gallstones in the common bile duct.
		This condition causes jaundice and liver cell damage, and is a medical emergency, requiring the endoscopic retrograde cholangiopancreatography (endoscopic retrograde cholangiopancreatography) procedure or surgical treatment.
		This obstruction will lead to jaundice, elevation in alkaline phosphatase, increase in conjugated bilirubin in the blood, and an increase in cholesterol in the blood.
	en.wikipedia.org /wiki/Choledocholithiasis (195 words)

	Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a ...
		Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method -- Zidi et al.
		Use of magnetic resonance cholangiography in the diagnosis of choledocholithiasis: prospective comparison with a reference imaging method
		Choledocholithiasis and bile duct stenosis: diagnostic accuracy of MR cholangiopancreatography.
	gut.bmj.com /cgi/content/full/44/1/118 (3022 words)

	Prediction of recurrent choledocholithiasis by quantitative cholescintigraphy in patients after endoscopic ...
		Prediction of recurrent choledocholithiasis by quantitative cholescintigraphy in patients after endoscopic sphincterotomy -- Lai et al.
		Prediction of recurrent choledocholithiasis by quantitative cholescintigraphy in patients after endoscopic sphincterotomy
		One hundred and forty nine patients who had EST and clearance of the bile duct for choledocholithiasis were selected.
	gut.bmj.com /cgi/content/full/41/3/399 (2687 words)

	HerbChina2000.com - Herbal Remedies - Choledocholithiasis
		An obstruction of the common bile duct can also lead to an obstruction of the pancreatic duct, which may cause pancreatitis.
		Choledocholithiasis occurs as a result of either the primary formation of stones in the common bile duct (CBD) or the passage of gallstones from the gallbladder through the cystic duct into the CBD.
		Bile stasis, bactibilia, chemical imbalances, pH imbalances, increased bilirubin excretion, and the formation of sludge are among the principal factors leading to the formation of these stones.
	www.herbchina2000.com /therapies/DCT.shtml (875 words)

	MedPix 2811: Choledocholithiasis - Medical Image Database and Atlas
		Although choledocholithiasis (bile duct stones) represents a diagnostic possibility in almost any setting of biliary stone disease, certain risk factors should be elicited from the patient to develop a diagnostic perspective.
		In the setting of jaundice, elevated serum bilirubin, and pancreatitis, a dilated common bile duct is should lead to a careful search for distal obstructing stones.
		Complications of choledocholithiasis include strictures, complicatiosn of operative procedures, and cholangitis.
	rad.usuhs.mil /medpix/topic_display.html?recnum=2811 (433 words)

	About Laparoscopic Common Bile Duct Exploration (LCBDE) and Bile Duct Stone Extraction
		In the United States, approximately 800,000 cases of laparoscopic cholecystectomy are performed annually, with stones (choledocholithiasis) detected in the common bile duct in 6-10% of the cases via intraoperative cholangiogram.
		In a case study comprising 1,353 laparoscopic cholecystectomies by Dr. Wenner and Associates, choledocholithiasis was diagnosed in 8.4% of those cases.
		A separate study by Dr. Heili, et al, ("Choledocholithiasis: Endoscopic versus Laparoscopic Management") of 913 cases conducted from 1990 through 1996 concluded that laparoscopic treatment costs less, requires shorter hospitalization, and resulted in significantly fewer complications.
	www.lapsurgical.com /about.html (663 words)

	Detection of Choledocholithiasis with MR Cholangiography: Comparison of Three-dimensional Fast Spin-Echo and Single- ...
		Detection of Choledocholithiasis with MR Cholangiography: Comparison of Three-dimensional Fast Spin-Echo and Single- and Multisection Half-Fourier Rapid Acquisition with Relaxation Enhancement Sequences -- Soto et al.
		However, the borders of the stone are blurred in b due to partial-volume averaging.
		Oblique coronal images show choledocholithiasis, with two stones in the common bile duct.
	radiology.rsnajnls.org /cgi/content/full/215/3/737 (4972 words)

	Arch Surg -- Abstract: Choledocholithiasis in acute gallstone pancreatitis. Incidence and clinical significance, May ...
		Arch Surg -- Abstract: Choledocholithiasis in acute gallstone pancreatitis.
		A prospective study of choledocholithiasis was performed using 110 patients
		duct (n = 5), suggesting that choledocholithiasis may not be the sole
	archsurg.ama-assn.org /cgi/content/abstract/126/5/566 (157 words)

	SAGES: Laparoscopic Common Bile Duct Exploration Is Superior for Choledocholithiasis (Site not responding. Last check: 2007-10-10)
		SAGES: Laparoscopic Common Bile Duct Exploration Is Superior for Choledocholithiasis
		NEW YORK, NY -- March 18, 2002 -- Laparoscopic common bile duct exploration, along with routine cholangiography, clears the bile duct and avoids further use of hepatobiliary instrumentation for common bile duct stones.
		The researchers came to the conclusion that laparoscopic common bile duct exploration should be the procedure of choice for choledocholithiasis both in acute and elective situations.
	www.pslgroup.com /dg/214e52.htm (410 words)

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