Choledocholithiasis is a condition during which gallstones are located within the biliary duct system. These stones often block the passage of bile which causes jaundice and damage to liver cells. This is a life-threatening condition which requires immediate treatment.
Most of the stones that exit the gallbladder can easily pass through the common bile duct. However, some stones are too large and they get stuck in the distal part of the common bile duct creating an obstruction.
During physical examination, Murphy’s sign is usually negative, which helps to distinguish choledocholithiasis from cholecystitis. To test for Murphy’s sign the patient is asked to breathe out, and then the doctor gently places his hand on the right side at the mid-clavicular line below the costal margin. The patient is then asked to breathe in, which makes the abdominal contents to be pushed downward (the gallbladder is pushed onto the doctor’s fingers). If this causes the patient to wince and stop breathing it, the test is considered to be positive.
Another important symptom is jaundice. The yellowish tint of the skin might not be noticeable at first, especially if the person is dark-skinned, so it’s better to look at the eyes, since the sclera of the eyes is also becoming yellow due to jaundice.
Clay-colored stool – the characteristic brownish color of the stool is given to it by the bile. If the bile is not reaching the small intestine, the stool may become clay-colored.
If the symptoms mentioned above are also followed by fever, then the patient might also have ascending cholangitis (inflammation of the biliary duct system).