Biliary tract stones

　　Biliary tract stones refer to the formation of stones in the intrahepatic and extrahepatic bile ducts, which are the most common bile duct diseases. Generally, the causes of biliary tract stones include the following points:

　　1. Irreversible factors

　　(1) Age of onset: The incidence of gallbladder stones increases with age. If onset occurs during childhood, it is often related to hemolytic or congenital biliary tract diseases. The peak age of onset is between 40 and 50 years.

　　(2) Gender differences in disease onset: The results of ultrasonic diagnosis show that the ratio of male to female onset is about 1:2, and female gallbladder stones are predominantly cholesterol stones. The high incidence of female cholesterol stones may be related to the fact that estrogen can increase the secretion of cholesterol in bile, reduce the total amount and activity of bile acids, and progesterone affects gallbladder contraction, leading to bile stasis.

　　(3) The relationship between disease onset and genetics, family history: The incidence of gallbladder stones varies significantly between races, indicating that genetic factors are one of the pathogenic mechanisms of cholelithiasis.

　　2. Reversible factors

　　(1) The relationship between disease onset and pregnancy: Pregnancy can promote the formation of gallbladder stones, and the number of pregnancies is positively correlated with the incidence of gallbladder stones. Due to the increase in estrogen during pregnancy, which changes the composition of bile, it can increase the saturation of cholesterol in bile; and the gallbladder emptying during pregnancy is slow; changes in weight and dietary structure during pregnancy and postpartum also affect bile composition, altering the enterohepatic circulation of bile acids and promoting the formation of cholesterol crystals.

　　(2) The relationship between disease onset and obesity: Clinical and epidemiological studies have shown that obesity is an important risk factor for the development of gallbladder cholesterol stones, with the incidence rate in obese individuals being three times higher than that in individuals with normal weight.

　　(3) Onset related to dietary factors. Dietary habits are the main factors affecting the formation of gallstones. The incidence of gallbladder stones is significantly higher in those who consume low-fiber, high-calorie foods. Because these foods increase the saturation of cholesterol in bile. With the improvement of living standards in China, the incidence of gallbladder stones has occupied a major position in gallstone diseases, and they are mainly cholesterol stones.

　　Bile duct stones refer to the formation of stones within the bile ducts inside and outside the liver, which is the most common bile duct disease. Stone blockage of the bile duct causes bile stasis, secondary bacterial infection, leading to the occurrence of acute cholangitis. Recurrent inflammation of the bile duct can cause thickening or scar-like narrowing of the local wall, while bile duct inflammation and stricture can promote stone formation. Let's take a specific introduction to the common complications that bile duct stones may cause.

　　1. Acute suppurative cholangitis

　　When bile duct stones are complicated with acute obstructive suppurative cholangitis, toxic shock and infectious shock can occur regardless of the location of the stone blockage, leading to multiple organ failure of the liver, kidney, lung, heart, and brain.

　　2. Liver abscess and bronchopleural fistula

　　On the basis of recurrent acute obstructive suppurative cholangitis, liver abscess can form, and its clinical symptoms are similar to those of acute suppurative cholangitis. When the abscess penetrates into the lung, it forms a bronchopleural fistula, and the clinical manifestations are coughing and expectoration of sputum. At this time, the symptoms of severe infection will decrease rapidly.

　　3. Bile duct hemorrhage

　　When recurrent inflammation corrodes and communicates with adjacent blood vessels, bile duct hemorrhage can occur. Clinical manifestations include periodic gastrointestinal bleeding, abdominal pain, fever, and other symptoms.

　　4. Bile duct stricture

　　Intrahepatic bile duct stones often lead to recurrent inflammation, damage, and repair of the bile duct wall, ultimately causing fibrotic stricture of the bile duct.

　　5. Biliary cirrhosis and portal hypertension

　　Diffuse intrahepatic bile duct stones can gradually lead to biliary cirrhosis, and further cause portal hypertension.

　　Bile duct stones refer to the formation of stones within the bile ducts, including both intrahepatic and extrahepatic bile ducts. So, how can we know if bile duct stones have occurred? Generally, this disease has the following common symptoms:

　　1. Typical Charcot's (charcot) triad accompanied by nausea and vomiting and gastrointestinal symptoms. Pain can radiate to the right scapular area. Stones impacted in the ampulla of Vater can cause persistent jaundice, dark urine, and light-colored stools.

　　2. Long course of disease, recurrent upper abdominal distension and pain, radiation to the right scapular area, often with chills and fever. Unilateral bile duct stones may not have jaundice, while bilateral bile duct stones often have Charcot's triad or Reynolds' pentad. In the late stage, portal hypertension is common, and stones in the left lateral lobe and right posterior lobe of the liver are more common.

　　3. Jaundice, tenderness and muscle tension under the xiphoid process or in the upper right abdomen, liver enlargement. Gallbladder enlargement with tenderness. In the later stage, there may be splenomegaly and ascites.

　　Intrahepatic bile duct stones refer to stones occurring above the confluence of the right and left hepatic ducts. There are many causes of this disease, including age-related, genetic, and dietary factors. Therefore, to prevent this disease, attention should be paid to the following points:

　　1. Prevent intestinal parasitic infections. Intestinal parasites are the primary disease of biliary tract infection and are closely related to bile pigment stones. Good hygiene habits should be cultivated, washing hands before and after meals, and washing raw fruits and vegetables, which can effectively prevent intestinal parasitic infections. Cultivating good hygiene habits is also very important. It is also necessary to actively treat primary diseases that can cause biliary tract stones, such as biliary tract infection, biliary parasites and eggs, hemolytic anemia, and cirrhosis, as these diseases are prone to induce biliary pigment stones.

　　2. Appropriate physical exercise can maintain a positive spirit, stable emotions, harmonize Qi and blood, keep the normal function of organs and viscera, and ensure the smooth flow of bile. Keeping the proportion of bile components normal can prevent the occurrence of choledocholithiasis. Physical exercise can help patients with choledocholithiasis recover a healthy body.

　　3. Reasonably arrange the daily dietary habits of patients with choledocholithiasis. Try to eat less high-cholesterol and high-fat foods and eat a variety of nutritious grain foods. For example, eat six types of food every day: grains, beans, meats, vegetables and fruits, oils, and sugars, and change the variety of each type of food regularly to achieve a reasonable nutritional balance and include reasonable nutritional foods, so that the body can absorb various nutrients.

　　4. Have regular meals three times a day and avoid long periods of fasting. This not only makes bile concentrate in the gallbladder, but cholesterol and lecithin are also prone to form large 'bubbles', increasing the viscosity of bile and forming bile sludge. Regular meals can make the thick bile empty regularly, preventing stagnation and effectively preventing the formation of stones and the occurrence of choledocholithiasis.

　　The diagnosis of intrahepatic bile duct stones in patients with simple bile duct stones without infection or other complications, especially during the 'stationary period' when it is easy to be misdiagnosed as hepatitis or gastrointestinal disease, should be distinguished. Imaging examinations are helpful for diagnosis and differential diagnosis. Ultrasound and PTC examination can show the distribution of intrahepatic bile duct stones and the stenosis and dilation of the hepatic bile ducts, which is of great significance for determining the diagnosis and guiding treatment. The X-ray characteristics of PTC include:

　　1. The common bile duct or left and right hepatic ducts have annular stenosis, with the bile ducts dilated at the proximal end, where shadow of stones can be seen.

　　2. The left and right hepatic ducts or a certain part of the intrahepatic bile ducts are not visible on imaging.

　　3. The intrahepatic bile ducts of the left and right lobes are asymmetrically, locally, spindle-shaped, or dumbbell-shaped dilated. CT also has important diagnostic value, especially for those with concurrent biliary cirrhosis and carcinoma.

　　Bile duct stones can be widely distributed within the two lobes of the liver, or limited to a specific lobe of the bile duct, with the left lateral lobe and right posterior lobe being more common. So, how should we prevent the occurrence of bile duct stones?

　　1. Patients with bile duct stones should not eat too much greasy food, avoid overeating and drinking excessively, and not drink too much alcohol.

　　2. The medication includes Jin Qian Cao (Desmodium strobilaceum), Yin Chen蒿 (Inula japonica), Ji Gu Cao (Bacopa monnieri), and others, with dosage adjusted according to symptoms. Medication should be taken under a doctor's guidance. High-fat foods should be avoided, and during the illness, foods high in cholesterol such as (the brains, livers, kidneys) of pigs, cows, and chickens, fish eggs, and yolks should be avoided.

　　3, At the same time, quit smoking and drinking, reduce meat intake, and avoid eating salty and fatty foods.

　　4, Avoid pork, pork liver, beef, pork kidney, animal brains, duck meat, sardines, crabs, etc.

　　5, Avoid spinach, green peas, lentils, and other legumes, as well as cauliflower and asparagus.

　　6, If calcium phosphate and magnesium ammonium phosphate stones are present, avoid the intake of calcium and phosphorus, such as milk, tofu, shrimp shells, kelp, fatty meat, egg yolks, etc.

　　7, If calcium oxalate stones are present, avoid radishes, spinach, chocolate, celery, potatoes, and soy products. Especially spinach.

　　Bile duct stones are divided into primary bile duct stones and secondary bile duct stones. Once the disease occurs, surgery is the main method of treating bile duct stones. Below, we will introduce the specific information for everyone.

　　1, Non-surgical treatment

　　Adopting a combination of traditional Chinese and Western medicine therapy, taking bile-promoting and stone-discharging decoction, magnesium sulfate, etc. Intravenous antibiotics. For those with obvious obstruction who cannot tolerate emergency surgery, PTCD bile drainage can be performed. For bile duct stones at the lower end of the common bile duct, endoscopic papillotomy of the duodenal papilla (EST) can be performed to gradually expel stones or to remove stones with instruments.

　　2, Emergency surgery indications

　　If the condition worsens, jaundice deepens, the gallbladder swells, there is marked tenderness, and signs of peritoneal irritation or the appearance of the Reynolds pentad occur 1-2 days after active anti-inflammatory and bile-promoting treatment, immediate cholecystotomy and stone extraction with drainage should be performed.

　　3, Elective surgery (suitable for chronic patients)

　　(1) Cholecystectomy and common bile duct exploration for stone removal, T-tube drainage, suitable for simple common bile duct stones.

　　(2) Ody's sphincteroplasty, suitable for patients with impacted stones at the lower end of the common bile duct or stenosis of the orifice.

　　(3) Hepatobiliary duct and jejunal Roux-Y anastomosis, suitable for patients with hepatic and extrahepatic bile duct stones, recurrent or residual stones, and strictures of intrahepatic bile ducts.

　　(4) Hepatectomy, suitable for patients with liver stones causing atrophy of a segment of liver tissue in a lobe of the liver.

　　(5) Choledochoduodenostomy, now rarely used, suitable for elderly and weak patients with recurrent gallstones who cannot tolerate complex surgery.

　　(6) Minimally Invasive Cholecystolithotomy, preserving the gallbladder, minimally invasive, less bleeding, advanced technology.