13.AUG.2020 3 MIN READ | 3 MIN READ

Bile duct stones may be the most common cause of obstructive jaundice in young to middle-aged adults, but with minimally invasive procedures, these stones can be quickly and easily treated.

Bile ducts are tiny tubes which carry bile juice produced by the liver to the duodenum, which is the first part of the small intestine. We may not mention them much in conversations about our body, but bile helps in the digestion of fat in the food that we consume. Yellow to green in colour, bile also imparts colour to the stools we expel. Bile is produced in the liver and stored in the gall bladder.

Once food enters the small intestine, the gall bladder contracts to transport the bile to the duodenum. Sometimes, stones which form in the gall bladder may drop into the bile duct, causing blockage. What results is a condition called jaundice or yellow discolouration of the eyes and tea-coloured urine.

How do bile duct stones develop?

How do bile duct stones develop
Stones in our bile ducts don’t actually originate there. Rather, they develop as gallstones in our gall bladder, where thick bile juice forms sludge, and then hardens into stones. These can range in size, from small grains to the size of a golf ball.

While most gallstones do not cause symptoms, they can move from the gall bladder into the bile ducts. When this happens, a condition called choledocholithiasis, commonly referred to as bile duct stones, happens.

The following factors increase your risk for developing gallstones:

    • Being 40 years or older
    • Diabetes mellitus
    • Family history of gallstones
    • Being female in gender
    • Consuming a high fat diet
    • Obesity
    • Pregnancy
    • Rapid weight loss
    • Use of birth control pills

What are the symptoms of bile duct stones?

Bile duct stones can cause pain in the upper right portion of the abdomen and pain is felt most often after a meal.

If the stone causes blockage of the bile duct, it can also cause the following symptoms:

    • Clay-coloured stools
    • Dark, tea-coloured urine
    • Fever
    • Loss of appetite
    • Nausea and vomiting
    • Severe, persistent abdominal pain
    • Yellowing of the skin and eyes

How are bile duct stones diagnosed?

Bile duct stone diagnosis
When bile duct stones are suspected, the doctor can request imaging tests to visualise the gallbladder and bile duct. These include an ultrasound, computerised tomography (CT) scan, and magnetic resonance imaging (MRI).

The role of ERCP

Endoscopic retrograde cholangio pancreatography (ERCP) is a procedure that allows the doctor to pass an endoscope from the mouth to the duodenum, then diagnose and remove the bile duct stones.

Before the procedure, you will be instructed not to eat or drink. The procedure is carried out under sedation and when you wake up, you will have no recollection of what happened. There should not be any pain or discomfort during or after the procedure.

During the ERCP, the doctor will inject a dye into the bile duct to localise the stones. Subsequently, the stones are removed using baskets or balloons which are inserted through the scope.

The procedure will take around 30 – 60 minutes. You will be allowed to go home once the effects of the sedatives wear off.

When should you see a doctor?

Do consult a doctor for an accurate diagnosis and treatment plan should you be experiencing any discomfort in your abdomen. Especially if you experience any of the following symptoms:

  • Pain in the abdomen especially after eating
  • Tea-coloured urine or light-coloured stools
  • Yellowing of the skin or eyes

 

Following the end of the circuit breaker period, Gleneagles Hospital and our 24-hour A&E clinic have resumed all healthcare services. If you or your family members require treatment for a medical condition, make an appointment with a specialist.

Our services are also available at other Parkway Pantai hospitals at the Mount Elizabeth Hospitals and Parkway East Hospital.

Rest assured we have implemented measures to safeguard the health of our patients, visitors and staff. Learn more about how we keep our hospitals safe.

 

Article reviewed by Dr Amitabh Monga, gastroenterologist at Gleneagles Hospital

References

LIndenmeyer CC. Imaging Tests of the Liver and Gallbladder, retrieved on 6 July 2020 from https://www.msdmanuals.com/professional/hepatic-and-biliary-disorders/testing-for-hepatic-and-biliary-disorders/imaging-tests-of-the-liver-and-gallbladder. (December 2019)

ERCP (Endoscopic Retrograde Cholangiopancreatography) Patient Information from SAGES, retrieved on 6 July 2020 from https://www.sages.org/publications/patient-information/patient-information-for-ercp-endoscopic-retrograde-cholangio-pancreatography-from-sages/#:~:text=ERCP%20is%20a%20procedure%20that,and%20pancreas%20to%20the%20intestines. (1 April 2020)

Smith L. Choledocholithiasis: What you need to know, retrieved on 6 July 2020 from https://www.medicalnewstoday.com/articles/318941. (14 August 2017)

Holland K. Choledocholithiasis, retrieved on 6 July 2020 from https://www.healthline.com/health/choledocholithiasis. (15 December 2017)

Barclay T. Gallbladder, retrieved on 6 July 2020 from https://www.innerbody.com/image_digeov/dige04-new.html#:~:text=The%20gallbladder%20is%20a%20small,duodenum%20of%20the%20small%20intestine. (16 July 2019)

Gallstones, retrieved on 6 July 2020 from https://www.mayoclinic.org/diseases-conditions/gallstones/symptoms-causes/syc-20354214#:~:text=Gallstones%20are%20hardened%20deposits%20of,your%20small%20intestine%20(duodenum). (8 August 2019)

Common bile duct, retrieved on 6 July 2020 from https://www.healthline.com/human-body-maps/common-bile-duct#1. (21 January 2018)

Bile Duct Stones, retrieved on 6 July 2020 from https://www.uofmhealth.org/conditions-treatments/digestive-and-liver-health/bile-duct-stones#:~:text=Bile%20duct%20stones%20are%20gallstones,bile%20duct%2C%20causing%20a%20blockage. (n.d.)

13.AUG.2020
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Amitabh Monga
Gastroenterologist
Gleneagles Hospital