I. The location of the common bile duct morphology?
1. the common bile duct is like the trunk of a tree.
2, positioned outside the liver.
3, the junction of the upper end with the common hepatic duct and the cystic duct are connected.
4, the upper part enters the liver with increasingly thin branches.
6, the lower end becomes smaller in diameter and opens in the inner posterior part of the descending duodenum.
2. Primary common bile duct stones?
1, originally formed in the common bile duct.
2, Most of them are bile pigment stones.
3. Soft in texture.
4, easy to recur.
C. Secondary common bile duct stones?
1, stones come from the gallbladder (stone color, shape and size, stone composition consistent with stones in the gallbladder);.
2, about 1/5 gallbladder stones (thicker gallbladder duct) can drain into the common bile duct.
3, secondary stones are usually smaller.
Fourth, common bile duct stones cause severe abdominal pain?
1, stones are easily embedded in the lower end of the common bile duct.
2, discharge of stones can stimulate the lower sphincter of common bile duct and cause sphincter spasm.
3, can be induced by eating a greasy diet, exertion, mental stimulation, etc.
4.Increased pressure in the bile duct.
V. Jaundice caused by common bile duct stones?
1, bile duct obstruction caused by common bile duct stones.
2, increased bile duct pressure, bile retrograde into the liver and into the blood vessels.
3, jaundice can appear after 8 hours of complete obstruction of the common bile duct.
4.The stone floats or discharges into the duodenum, and the jaundice can gradually subside.
Sixth, common bile duct stones cause chills and fever?
1, bile duct obstruction and bile stasis.
2, secondary infection.
3, predominantly gram-negative bacillary infection infection and anaerobic bacterial infection.
4, infected bile retrograde into the blood.
5, stone obstruction of the duodenal jugular or pancreatic duct causing acute pancreatitis (biliary origin).
VII. What is Charcot’s triad?
1, abdominal pain, jaundice, chills and fever are called “Charcot’s triad”.
2. It is an important diagnostic indicator of common bile duct stones.
What are the diagnostic criteria for severe cholangitis?
1. “Charcot’s triad” plus decreased blood pressure and psychiatric symptoms (five signs).
2. It is a critical surgical emergency, which can easily lead to the death of the patient.
3, emergency surgery while fighting shock, focusing on stone removal and bile duct decompression and drainage.
Endoscopic treatment of common bile duct stones?
1, transduodenoscopic papillotomy for stone extraction (EST)
2, transnasal bile duct drainage (ENBD), etc.
3.Triple-scope combined treatment (duodenoscopy + choledochoscopy + laparoscopy) is possible.
X. Open surgery treatment of common bile duct stones?
1.Choledochotomy for stone extraction.
2, T-tube drainage of the common bile duct.
3, scar stenosis of lower common bile duct, dilated intrahepatic bile duct without stenosis, diameter of common bile duct more than 2 cm, can be made jejunal common bile duct Roux-Y anastomosis.