Parasites and Biliary stones

Choledocholithiasis ٧٣
jaundice that fluctuates in intensity, especially if accompanied by fever
and abdominal pain, is characteristic of gallstone disease. Pyrexia with
rigors suggests cholangitis associated with gallstones or biliary strictures
(Bithartz and Horton, 1998). Anaemia and gross weight loss suggest
cancer. The patient with prolonged biliary obstruction has deep greenish
color. Sites to be examined for primary tumour include the breasts,
thyroid, stomach, colon, rectum & lung. Lymphadenopathy also should
be noted (Schwartz, 2005).
Complication:
Acute biliary obstruction is caused partly by the presence of stone
itself, and partly by oedema of the duct wall that may be enhanced by the
spasm of sphincter of Oddi. Chronic intermittent biliary obstruction
occurs when a stone moves up and down in the ducts; it may produce
repeated and transient episodes of jaundice. However, chronic obstruction
results in progressive dilatation of the ducts which may become twice
their normal caliber (Ellis, 1990).
Although Hoemobilia is a rare complication, it presents with the
triad of biliary colic, obstructive jaundice, and occult or gross intestinal
bleeding (Lawrence and Way, 1994 and Doherty and Way, 2003).
A fistulous track between the lower end of the CBD and the
duodenum (a cholecocho-duodenal) fistula may occur secondary to ductal
calculi (Cuschieri, 2002).
A stone in the CBD may erode through the ampulla resulting in
gallstone ileus, Hepatic failure or secondary biliary cirrhosis may develop
in unrelieved obstruction of long duration (Doherty and Way, 2003).
Acute cholangitis secondary to bile-duct stones develops when
bacterial infection complicates obstruction within the biliary tract.