Wednesday, September 10, 2014

Lets Talk About Stones in the Common Bile Duct

  This drawing shows that even when the gallbladder is gone, bile can exit the liver and form stones which become stuck in the common bile duct which must remain following cholecystectomy. The pain of such a stone is often perceived to be in the stomach.    (  Rendering found at: )


          Many, many people, especially those of us with very fair skin, had our gallbladders removed fairly early in life.  Mine was removed during emergency surgery when it was discovered that I had a gangrenous gallbladder at only twenty-eight. I was somewhat incredulous because I had been under the impression that one needed to be overweight to be troubled by serious gallbladder disease, and this is not at all true. The people for whom gallbladder disease is most common are those who are fair, fat, female, fertile, or forty.  However, I know plenty of male physicians who have had theirs removed in a hurry also.  Pregnancy, or pregnancies in rapid succession may also contribute to gallbladder disease, as can some gastrointestinal viral illnesses.  Some patients who have recently been diagnosed with hypothyroidism may also have difficulty resolving a gastrointestinal illness which in turn creates gallbladder irritation and gallbladder disease. Some people or some families simply lean toward the production of gallstones which are simply stones which form from bile, and are either made of bile salts or cholesterol.

             Most of us believed that once our gallbladder was gone, that gallstones and the excruciating colicky pain they can bring, were a thing of the past.  Although this is true for most, it is not true for everyone.  Even when the gallbladder has been removed, it is still possible for the bile produced by the liver, to occasionally produce a stone which can deposit itself in the remaining common bile duct.  If it does, the pain can be very similar to the pain experienced in a gall bladder attack. One of the medical research articles I read, said that "a considerable number of people after cholecystectomy (gallbladder removal surgery), experience a common bile duct stone (CBD stone) afterward.   This of course, explains one patient I had who insisted that "her gallbladder must have grown back" because she was experiencing the same colicky pain, cool clammy skin, and profuse diaphoresis (sweating) that she had with gall bladder attacks  (cholecystitis)

This is a picture of a patient with a gallbladder intact, which is filling with stones, and likely needs to come out.

 What can be done to avoid this ?   Well first, if your gallbladder was removed in 1976 and your abdomen is quiet, then absolutely nothing at all.   However, if you are troubled by episodic colicky pain in the epigastric (in the region of your stomach, the organ, just below your breast bone) then see your doctor and ask about the possibility of a stone which might be occurring periodically in your common bile duct.  Don't allow yourself to become dehydrated, as this may contribute to thickened bile and more of a tendency toward stone production.  Your physician may wish to get some bloodwork, and may check your liver enzymes, as a blockage in the common bile duct can result in reflux of bile from the liver, back into the liver where it not only can damage tissue, but can produce absolutely excruciating pain, and other complications. It is also possible for a common bile duct stone to result in damage to the pancreas, so this issue can truly become a medical emergency.  Jaundice, in which the patient develops and yellow skin and sclerae (whites of the eyes) can also occur and this can be exceedingly dangerous.  Additional testing, including some scans will  be necessary.

        As a person interested in preparedness, there is not a great deal one can do to avoid such stones if your family is one of those who has the predilection for their formation.  Things you could do in an attempt to prevent them could be to avoid dehydration.  Drink mostly water as it will tend to thin bile, and sugared or fatty drinks will tend to increase bile formation.  Avoid excess weight around the waistline because this places pressure on all your abdominal organs (as well as increases your chances for Type II diabetes.)  Avoid extremely rapid weight loss as it tends to create bile sludge and can possibly result in stone formation, just as it can in those who still have their gallbladder.

          Should you or a family member experience gall bladder like pains even following cholecystectomy (the removal of the gallbladder), it is exceedingly important that this be assessed and treated if necessary, before a national emergency of some type where both transport and care could be hard to come by.

My prior posts concerning the gallbladder:

These are some references you, or your physician might like to read:

 Another time, we may speak about some other post cholecystectomy syndromes.