Parasites and Biliary stones

Choledocholithiasis ٧٢
The symptoms of cholangitis are described by Charcot’s triad of
jaundice, fever and pain in up to 75% of patients. However, in a minority
of patients (12%) pain alone may be the only presenting feature of
cholangitis (Anciaux et al., 1986). Between 4% and 8% of patients with
gallstones will develop gallstone pancreatitis secondary to migratory
gallstones (Ayub et al., 2004). Developing gallstone pancreatitis is more
likely with smaller stones than with larger stones. Patients presenting
with gallstone pancreatitis had mean diameter bile duct stone size of 4
mm compared to that of 9 mm for patients presenting with obstructive
jaundice (Venneman et al., 2005). The majority of these patients will
have a self limiting disease but mortality still remains around 10% (Toh
et al., 2000).
B- Signs:
The patient may be icteric and toxic, with high fever and chills, or
may appears to be healthy (Doherty and Way, 2003). In the jaundiced
patient, it is useful to remember Courvoisier’s law in obstruction of CBD
due to a stone, distension of the gallbladder seldom occurs. However, if
there is no disease in the gallbladder and the obstruction is due to a cancer
of the ampulla, pancreas or bile duct, then the gallbladder may will be
distended (Russel et al., 2000). In cholangitis, the classic description of
Charcot’s triad is often encountered. The less common Reynold’s pentad
adds the elements of systemic shock and mental status changes
(Schwartz, 1999 and Halpin and Soper, 2001).
The cause of jaundice in an individual patient can be diagnosed or at
least suspected from the clinical history, physical examination and routine
laboratory tests (Canto et al., 1998). The mode of onset is extremely
important factor in the diagnosis. The insidious appearance of deep
jaundice over few weeks should suggest neoplastic obstruction. While