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Choledocholithiasis

 Syn. Bile duct stones , Bile duct stone , CBD

Signs & Symptoms

 Right upper quadrant pain
Ref: Uptodate [ Diagnostic approach to abdominal pain in adults]
Pain persisting beyond 5 hours
Ref: Harrison [ 2426]
Gilbert syndrome
Ref: Uptodate [ Gilbert syndrome and unconjugated hyperbilirubinemia due to bilirubin overproduction]
nonspecific abdominal discomfort (negative symptom)
Ref: Uptodate [ Uncomplicated gallstone disease in adults]

Physical Examination

 Acute elevated bilirubin
Ref: Uptodate [ Approach to the patient with suspected choledocholithiasis] Uptodate [ Diagnostic approach to abdominal pain in adults]
Acute onset of upper abdominal pain
Ref: Cecil [ 472]
Elevated serum liver tests
Ref: Uptodate [ Diagnostic approach to abdominal pain in adults] Harrison [ 2199]

Lab / Serology

 Elevated Serum aspartate aminotransferase
Note: due to biliary obstruction
Ref: Uptodate [ Approach to the patient with suspected choledocholithiasis]
Acute elevated bilirubin
Ref: Uptodate [ Approach to the patient with suspected choledocholithiasis] Uptodate [ Diagnostic approach to abdominal pain in adults]
Elevated Serum alanine aminotransferase
Note: due to biliary obstruction
Ref: Uptodate [ Approach to the patient with suspected choledocholithiasis]

Imagin Study

 gallstones
Ref: Uptodate [ Uncomplicated gallstone disease in adults]
demonstrate gallstones
Ref: Uptodate [ Uncomplicated gallstone disease in adults] Harrison [ 2427] Cecil [ 472]
MRCP reveal stone
Ref: Cecil [ 473]

Complication

 Pain persisting beyond 5 hours
Ref: Harrison [ 2426]
Attack of biliary pain
Ref: Harrison [ 2427]
Acute onset of upper abdominal pain
Ref: Cecil [ 472]

Risk Factors

 Family gallstones
Ref: Unknown [ 0]
Family history of gallstones
Ref: Unknown [ 0]
Cirrhosis
Ref: Unknown [ 0]

Cause

 malabsorption of bile acids
Note: due to depletion of the bile salt pool and the secretion of lithogenic bile
Ref: Harrison [ 2269]
Caused by malabsorption of bile acids
Note: due to depletion of the bile salt pool and the secretion of lithogenic bile
Ref: Harrison [ 2269]

Other