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**Closure of my websites askdrray.com and nethealthbook.com**

These websites will be taken down on **April 30, 2025** and no further updates will be provided.
I hope you enjoyed the content of these websites. You can continue to read Dr. Schilling’s blogs which I publish daily on Quora

My home page there is: ** https://www.quora.com/profile/Ray-Schilling**

Click on this: Under my image there is a heading “Profile”. Right underneath this you find a search box entitled “search content”. Type in any term you are interested in. You will get several answers I have written (I have written more than 15,000 answers).

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Common Bile Duct Stone

Introduction

On the positive side, when the bile ducts are open and functioning normally life is pleasant, but on the negative side, a common bile duct stone is causing trouble.

Sometimes a gall stone, perhaps from gall stones in the gall bladder, eventually finds its way into the common bile duct and gets caught at the sphincter of Oddi. It is there where the common bile duct opens into the duodenum. Suddenly several things happen at the same time.

There is an excruciating biliary colic in the right abdomen, the bile flow is interrupted and the bile that continues to be produced backs up into the liver causing jaundice. The backed up bile is an excellent growth medium for bacteria such as E. coli or salmonella strains. As a result infections are common.

Symptoms

Therefore, fever, right abdominal pain with colics, jaundice, nausea, vomiting are the common symptoms. The stone may press on the main pancreatic duct, in which case there would be an acute pancreatitis on top of the other symptoms (see symptoms there). The patient may be very sick.

 Common Bile Duct Stone (Anatomy)

Common Bile Duct Stone (Anatomy)

Treatment

The objective is to remove the stone. To achieve this, the physician (gastroenterologist and/or general surgeon) wants to localize the stone exactly. This is done with a combination of one or several of the following tests: ultrasound, CT scan, ERCP, percutaneous transhepatic cholangiography. The most elegant way to remove a stone in the common bile ducts is through an endoscopic retrograde spincterotomy with the ERCP endoscope. This method has the least mortality and complication rate. However, if this is technically difficult or impossible to do, then the surgeon can do the traditional surgery through an abdominal incision, opening the common bile duct this way and removing the stone. Furthermore, the physician treats infection with intravenous antibiotics.

References

1. DM Thompson: The 46th Annual St. Paul’s Hospital CME Conference for Primary Physicians, Nov. 14-17, 2000, Vancouver/B.C./Canada

2. C Ritenbaugh Curr Oncol Rep 2000 May 2(3): 225-233.

3. PA Totten et al. J Infect Dis 2001 Jan 183(2): 269-276.

4. M Ohkawa et al. Br J Urol 1993 Dec 72(6):918-921.

5. Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages 976-983: “Chapter 107 – Acute Abdomen and Common Surgical Abdominal Problems”.

6. Marx: Rosen’s Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:”Abdominal pain”.

7. Feldman: Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002 Elsevier, p. 71: “Chapter 4 – Abdominal Pain, Including the Acute Abdomen”.

8. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

Last modified: August 29, 2018

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.