Fact-sheet: Cholelithiasis
Updated on 10/07/2017 at 6:39 AM
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Definition
The most common choledochal lithiasic obstruction of biliary origin, causing biliary colic, cholangitis, or pancreatitis.
Clinical features
Asymptomatic
Right upper quadrant pain radiating to the right shoulder.
Jaundice.
Fever.
Diffuse abdominal pain
Laboratory findings
Unremarkable Cytolysis predominating on ALT. Cholestasis. Biological inflammatory syndrome Hyperlipasemia
Ultrasound
Dilatation of the intrahepatic and extrahepatic bile ducts.
Possible visualization of an impacted stone in the common bile duct, echogenic with +/- posterior acoustic shadowing
CT
Unenhanced acquisition ++
Dilatation of the intrahepatic and extrahepatic bile ducts.
Possible dilatation of the Wirsung duct.
Possible visualization of an impacted stone in the common bile duct if calcified, spontaneously hyperdense.
MRI
MRCP:
the most sensitive and specific examination.
Hypointense stone within hyperintense bile.
Interpretation more difficult if the stone is not surrounded by bile.
Management
Therapeutic abstention if asymptomatic and incidentally discovered.
Sphincterotomy by endoscopic ultrasound if symptomatic.
External or internal biliary drainage and antibiotic therapy if cholangitis and endoscopic ultrasound is unavailable