Fast Five Quiz: Test Your Knowledge of Gallstones

Jamie Shalkow, MD;  Daniel Margain, MD


June 12, 2018

Stones in the common bile duct may be asymptomatic, but, more commonly, they impact distally in the ampulla of Vater. This may produce biliary colic indistinguishable from that caused by cystic duct stones. Because impaction of common bile duct stones occludes the flow of bile from the liver to the intestine, pressure rises in the intrahepatic bile ducts, leading to elevation of liver enzymes and jaundice. Stone impaction in the distal common bile duct is often relieved spontaneously within hours to days by passage of the stone into the intestine.

Chronically, gallstones may cause progressive fibrosis of the gallbladder wall and loss of gallbladder function, termed chronic cholecystitis. The pathogenesis of this complication is not completely understood. Repeated attacks of acute cholecystitis may play a role, as may localized ischemia produced by pressure of stones against the gallbladder wall. The chronically fibrotic gallbladder may become shrunken and adherent to the adjacent viscera.

Occasionally, a large stone may erode through the wall of the gallbladder or the common bile duct into an adjacent viscus (typically the duodenum), producing a cholecystoenteric fistula. The stone, if sufficiently large, may obstruct the small intestine, usually at the level of the ileum, a phenomenon termed gallstone ileus.

Other complications of chronic cholelithiasis include cholangitis, acute pancreatitis, and gallbladder cancer.

For more on complications associated with cholelithiasis, read here.


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