Choledocolithiasis Pathophysiology

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) Genetics Diabetes Mellitus Metabolic Syndrome Crohn’s Disease Cirrhosis Blood Disorders (Sickle cell Anemia)

Modifiable Pregnancy Use of Hormone Replacement Therapy (Estrogen) Obesity Weight-cycling 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 to dislodge the stones

Spasm of the biliary tracts causing biliary colic or pain in the RUQ

Inflammation occurs (Cholangitis)

Backflow of conjugated bilirubin to Liver

Conjugated Bilirubin enters bloodstream Fever is experienced Jaundice occurs

Patient becomes restless and changes position frequently to relieve pain

Presence of Icteric Sclera and yellow skin

Nausea and Vomiting may occur