Current Understanding of Choledocholithiasis: Clinical Presentation and Preoperative Evaluation
Gallstones occur in about 20% of the general population, with 20% of gallstone patients also having common bile duct stones. The vast majority of gallstones are cholesterol stones, which form when bile becomes supersaturated with cholesterol. Up to half of common duct stones are asymptomatic. The most common clinical syndromes due to gallstones include biliary colic, jaundice, cholangitis, and gallstone pancreatitis. These latter two vary in severity and can be life-threatening. Preoperative evaluation takes into account patient symptoms, physical exam, and laboratory and imaging studies. Common duct stones may be detected using ultrasound, computed tomography, magnetic resonance cholangiopancreatography, or biliary scintigraphy. These modalities differ in their efficacies, and each has advantages and disadvantages that should guide their use.
KeywordsGallstones Cholelithiasis Choledocholithiasis Biliary colic Cholangitis Gallstone pancreatitis MRCP CT cholangiography Biliary scintigraphy
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