Parasites and Biliary stones

Choledocholithiasis ٦٩
Choledocholithiasis
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
(Schwartz, 1999).
About 15% of patients with gallstones have choledocholithiasis.
Stones in the common duct usually originate in the gallbladder but may
also form de novo in the bile duct. Like gallbladder stones, common duct
stones may remain asymptomatic for years and, if small, pass painlessly
from the bile duct into the duodenum. More typically, they remain in the
common duct and the patient presents with biliary pain, obstructive
jaundice, ascending cholangitis (bacterial infection in the bile duct), or
biliary pancreatitis (Sgourakis et al., 2005).
Choledocholithiasis develops in about 10-20% of patients with gall
bladder stones (Freitas et al., 2006), and occur in up to 3% -10% of all
cholecystectomy patients (Schirmer et al., 2005).
Classification:
CBD stones are classified according to origin: Primary bile-duct
stones, forming initially in the bile ducts; secondary to gallbladder stones,
originating in the gallbladder and passing into the bile ducts; and
secondary to or coexisting with intrahepatic bile-duct stones (Kaufman
et al., 1989).
Primary ductal calculi:
Pathogenesis: Primary ductal calculi that originate in the CBD are brown
pigment stones. In surgical practice, brown pigment stones are often