Diagnosis of Choledocholithiasis

The initial step is it figure out if the patient has cholelithiasis (stones within the gallbladder), since choledocholithiasis is one of the complications of cholelithiasis.

The most common symptoms of cholelithiasis is pain in the right hypochondrium, as well as nausea and vomiting, especially when the person decides to eat a fatty meal. Cholelithiasis can also be confirmed using ultrasound.

After the diagnosis of cholelithiasis has been established, the next step is to verify whether the patient has choledocholithiasis:

bilirubin-lab-testing

    • Raised levels of bilirubin and alkaline phosphatase – when the common bile duct gets obstructed by a foreign object, the pressure within it increases and the bile gets reabsorbed back into the bloodstream. This causes levels of direct bilirubin and alkaline phosphatase to rise.
    • Increased levels of amylase and lipase – besides obstructing the common bile duct, the stone can also obstruct a pancreatic duct. This can trigger an acute pancreatitis which causes the levels of amylase and lipase to rise.




  • The most reliable methods of confirming choledocholithiasis are:

MRCP

  1. MRCP (magnetic resonance cholangiopancreatography) – is a relatively new imaging technique which allows to view the biliary system, including gall bladder and common bile duct, and pancreatic duct, using radiofrequency waves.
  2. ERCP (endoscopic retrograde cholangiopancreatography) – this technique involves using an endoscope and fluoroscopy to view the biliary system and the pancreatic duct. This technique is rarely used as a diagnostics tool, since it can introduce bacteria to the biliary or pancreatic duct system, triggering acute pancreatitis or acute cholecystitis.

The diagnosis of choledocholithiasis can also be made during the removal of the gallbladder. During the operation the surgeon can obtain a cholangiogram and if there is a stone within the duct system, the surgeon can attempt to push the stone into the intestine or retrieve it through the cystic duct.





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