Common bile duct stones

　　Secondary common bile duct stones originate from the gallbladder, which are small stones in the process of the occurrence and development of gallbladder stone disease. They descend into the common bile duct through the cystic duct or have a relatively large diameter of the cystic duct. Larger stones can also enter the common bile duct in turn. Most of the stones that remain in the common bile duct will cause various severe pathological damage, which is actually a severe complication of gallbladder stone disease. Primary common bile duct stones are part of primary bile duct stones and can originate from the common bile duct, or occur simultaneously with intrahepatic bile duct stones. Sometimes, they may also descend from the intrahepatic bile duct. Primary common bile duct stones alone can cause severe biliary complications, and if they coexist with intrahepatic bile duct stones, the pathological damage will be more severe.

　　If patients with common bile duct stones do not receive timely and effective treatment, they may very likely lead to the following complications:

　　1. Acute suppurative cholangitis

　　Acute suppurative cholangitis is the most common complication of primary bile duct stones, also known as biliary infection. The clinical manifestations of primary bile duct stones are mostly related to it.

　　2. Cholangiocarcinoma abscess

　　Cholangiocarcinoma abscess is commonly seen with multiple small abscesses. There may be upper right abdominal pain, or there may be no abdominal pain. It is manifested as chills and high fever, with remittent fever type. Jaundice may or may not be present, and the course of the disease is generally long.

　　3. Biliary hemorrhage

　　Biliary hemorrhage is a relatively serious complication of primary bile duct stones.

　　4. Cholangiocarcinoma cirrhosis

　　Cholangiocarcinoma cirrhosis is a late complication of primary bile duct stones and belongs to late biliary diseases. In severe cases, it is accompanied by portal hypertension, splenomegaly, and hypersplenism. In addition to the symptoms of bile duct stones, it also has the manifestations of cirrhosis and portal hypertension.

　　5. Cholangiocarcinoma

　　Most scholars believe that the occurrence of cholangiocarcinoma is related to primary bile duct stones. In particular, patients with intrahepatic bile duct stones complicated by infection have a higher incidence of intrahepatic bile duct cancer, also known as cholangiocellular liver cancer. It is often masked by the symptoms of primary bile duct stones and is easily missed before surgery.

　　6. Biliary pancreatitis

　　Primary bile duct stones complicated with acute pancreatitis are much less than secondary bile duct stones, which may be related to the fact that most patients with primary bile duct stones have a relaxed state of the Oddi sphincter.

　　The most typical clinical manifestations of choledocholithiasis are upper abdominal colic,穿透性背痛,shivering,high fever,jaundice,etc.; if the lower end of the bile duct is completely obstructed, the cystic duct is patent, and the gallbladder wall has not yet fibroted and atrophied, then there is an enlarged and tender cystic mass in the upper right abdomen; the liver is symmetrically and diffusely enlarged and tender; the patient presents with remittent high fever, liver cell damage, and bile stasis, a series of toxic symptoms, collectively known as acute obstructive suppurative cholangitis.

　　Reasonable prevention is the key to reducing the occurrence of diseases, so how should we prevent choledocholithiasis? The following will introduce it for you:

　　1. Pay attention to diet, and food should be light and fresh. Eat less greasy and fried or roasted foods, and consume high-fat foods in moderation.

　　2. Overcome the bad habit of not having breakfast to avoid fat accumulation and eventually lead to gallstones.

　　3. Change the sedentary lifestyle, exercise regularly, and lose weight in a timely manner.

　　4. Cultivate a peaceful nature and avoid losing your temper. People with long-term family disharmony and emotional discomfort can trigger or worsen this disease. It is necessary to have a broad mind and a comfortable mood.

　　5. Pay attention to food hygiene and develop good hygiene habits.

　　6. Keep the bowels smooth and easy. The six visceras are used for their smoothness. When the liver and gallbladder are damp-heat and constipation, the symptoms worsen. Therefore, it is very important to keep the bowels smooth and easy.

　　Choledocholithiasis can usually be diagnosed by routine imaging examinations, and the following are common examination methods:

　　1. B-ultrasound examination is inexpensive and non-invasive, with an accuracy rate of 98% for gallbladder stones, but due to the influence of hollow viscus organs such as the duodenum, the accuracy rate for choledocholithiasis is only about 50%, especially difficult to display the bile duct in the posterior part of the duodenum, with a high rate of false positives and false negatives.

　　2. CT tomography is superior to ultrasound in the diagnosis of choledocholithiasis, with an accuracy rate of about 80%, but it is difficult to show pathological changes of the bile duct system and the status of stone number, size, and distribution.

　　3. ERCP and PTC examinations can clearly show the overall picture of the bile duct system, and can provide a relatively accurate size, number, location, and pathological changes such as dilation and stricture of the intrahepatic and extrahepatic bile ducts and gallbladder stones, which is the most important examination method for obtaining an accurate preoperative diagnosis.

　　4. Magnetic Resonance Cholangiopancreatography (MRCP) is non-invasive, does not require contrast agent, can well display the bile and pancreatic ductal system, and can show gallstones in the common bile duct, but the image clarity is not as good as ERCP or PTC.

　　To help patients with choledocholithiasis recover better, the following several food therapy recipes are recommended for you to try.

　　1. Egg and Cucumber Vine Drink

　　100 grams of cucumber vine and 1 fresh egg. After washing the cucumber vine, boil it in water to 100 milliliters, and then mix the juice with the egg. Take once a day, it can help cool the body and promote bile flow, but it is not suitable for people with deficiency and cold.

　　2. Purslane and Rehmannia Root Drink

　　10 grams of purslane, 25 grams of rehmannia root. Boil with water or soak in hot water, and drink as tea. It has good anti-inflammatory and diuretic effects.

　　3. Perilla and Chrysanthemum Porridge

　　25 grams of perilla, 15 grams of chrysanthemum, and 50 grams of glutinous rice. First, cook the glutinous rice to 80% maturity, then add perilla and chrysanthemum together and cook until boiling. Eat once a day. It can help eliminate inflammation and promote bile flow.

　　4. Kumquat and Hawthorn Porridge

　　50 grams of kumquat, 12 grams of hawthorn, and 100 grams of glutinous rice. First, cook the glutinous rice to 80% maturity, then add the kumquat and hawthorn, and cook until soft. Eat once a day, and it can help eliminate inflammation and digestion.

　　5. Four Flavor Drink

　　Boil 10 grams of loofah seeds, fried radish seeds, lychee kernels, and orange peel in water, and then take the juice. Take once a day, and drink warm. It is suitable for right-side rib continuous distension and pain, alternating between chills and fever, and sometimes abdominal distension and fullness.

　　Patients with common bile duct stones often seek medical attention when they experience pain, fever, or jaundice due to acute cholangitis. It is difficult to clearly determine the location, number, and pathological changes of the bile duct system during the acute inflammatory phase, and it is not advisable to perform complex surgical procedures. If surgical treatment is required, there is a high chance of needing additional surgeries. However, if the obstruction and inflammation are severe, conservative treatment is often ineffective. Therefore, appropriately mastering the relationship between surgical and non-surgical treatment in emergency situations is of great importance. Generally, it is best to avoid emergency surgery. Non-surgical measures should be taken to control the acute inflammatory phase, and elective surgery is preferable after symptoms subside. Through strong anti-inflammatory, anti-shock, intravenous fluid therapy to maintain water, electrolyte, and acid-base balance, nutritional support, and symptomatic treatment, percutaneous liver puncture bile duct drainage or endoscopic papillary incision for stone removal, placement of nasobiliary tube drainage to reduce pressure, can often be effective. After 12-24 hours of non-surgical conservative treatment, if there is no improvement or the condition continues to worsen, such as persistent typical Charcot's triad or the appearance of shock, consciousness disorders, and other severe acute obstructive suppurative cholangitis, timely bile duct exploration and decompression should be performed. The surgical treatment principles and objectives for common bile duct stones in Western medicine are mainly to remove stones, relieve obstruction, ensure bile flow, and prevent infection.