Choledocholithiasis

Definisi
Batu empedu di common bile duct yang dapat besar atau kecil serta dapat single atau multiple yang ditemukan pada 6-12% pasien
yang menderita batu empedu. Diklasifikasikan sebagai secondary common bile duct stones yang termasuk cholesterol stones.
Etiologi
1. Stones
2. ascaris lumbricoides
3. clonorchis sinensis
Epidemiology
Insidensinya meningkat pada:
1. Pada wanita, 20 - 25 % nya adalah usia diatas 60 tahun, multi parity
2. Untuk ras asia, biasanya sumbatan paling banyak di karenakan ascaris lumbricoides
Pemeriksaan fisik
1.
2.
3.
4.
5.

Tenderness, terutama di temukan di right upper quadrant atau mild epigastric

Mild icterus
Fever, hypotension
Nausea and vomiting
Transient jaundice, bila batunya completely impacted, dapat menyebabkan jaundice yang parah.

Lab finding
Peningkatan serum bilirubin, alkalin phosphatase dan transaminase
Diagnosis
1. USG: untuk mengetahui ukuran batunya dan melihat dilatasi common bile duct
2. MRC
3. Endoscopic cholangiography

Diagnosa Banding
1. Gallbladder cancer/ tumor
2. Cholangitis
3. Pancreatitis acute
4. Ascariasis
5. Cholescystitis
6. Abdominal trauma
7. Biliary colic/ biliary obstruction
Treatment
1. Preoperative endoscopic cholangiography atau intraoperative cholangiogram terlebih dahulu untuk melihat letak dan
memastikan keberadaan batunya.
2. Sphincterectomy
3. Laparoscopic cholecystectomy

Choledocolithiasis Pathophysiology
Risk factors
Non-modifiable
Sex (Females are more prone)
Age (75 y/o above Females = 50% Males = 20%)
Ethnicity (Native Americans such as Pima Indians,
Northern Europeans and South Americans)

Modifiable
Pregnancy
Use of Hormone Replacement Therapy (Estrogen)
Obesity
Weight-cycling

Genetics
Diabetes Mellitus
Metabolic Syndrome
Crohns Disease
Cirrhosis
Blood Disorders (Sickle cell Anemia)

Prolonged Parenteral feeding

Medications (Octeotrides)
Diet (Increase intake of Heme Iron, Fatty foods and Alcohol)

Bile becomes supersaturated with cholesterol or calcium or

excess unconjugated bilirubin or both and has decrease bile salts

The solute precipitates from solution to solid crystals

Crystals come together to form stones, either Cholesterol, Pigment or Mixed in the Gallbladder or Common Hepatic Duct
A small stone may pass from the gallbladder to the common hepatic duct
Obstruction in the common hepatic duct

Body tries
Nausea

to dislodge the stones

and Vomiting

Inflammation occurs
(Cholangitis)

Spasm of the biliary tracts

causing biliary colic or
pain in the RUQ

Backflow of conjugated
to Liver

may occur
Conjugated Bilirubin enters bloodstream

Fever is experienced
Jaundice occurs

Patient

becomes restless and

bilirubin

changes position frequently

to relieve pain

Presence of Icteric Sclera and

yellow skin