Common bile duct stones The gallbladder is located in the upper right abdomen, below the liver, and its main function is to store bile produced by the liver and release it when the body needs to use it. The main components of bile are cholesterol, water, salt, fat, protein, and metabolites (bilirubin). The common bile duct is the duct that carries bile to the duodenum to aid in the digestion of fats. A common bile duct stone is a stone like fragment that has been deposited in the common bile duct by material from the gallbladder, or it may be a stone from the gallbladder that has fallen into the common bile duct through the cystic duct. The size and number of stones varies from person to person. Causes: Excess cholesterol in the bile is the most important cause of stone formation in the bile. Excess bilirubin or insufficient bile salts are also responsible for the formation of stones, the exact cause of which is not yet known. Factors known to increase the likelihood of gallbladder stones include: Women are twice as likely as men to develop gallstones, especially during pregnancy, on hormone replacement therapy, and on birth control medications Family history of gallstones Obesity and overweight High-fat, high-cholesterol diet Excessive dieting and rapid weight loss Advanced age (significantly increased likelihood of gallstones over age 60) Taking cholesterol-lowering medications Diabetes Symptoms. Smaller bile duct stones do not always present with symptoms and are usually found during a physical examination. Larger bile duct stones can cause obstruction of the bile ducts, which can lead to inflammation of the bile ducts or gallbladder and even of the liver and pancreas. Symptoms include pain in the right upper abdomen (pain in the gallbladder fossa, which usually lasts from 30 minutes to several hours), pain in the back of the shoulder, pain in the right shoulder, nausea, vomiting, fever, and yellowing of the skin, eyes, and urine. Diagnosis: Because bile duct stone symptoms are similar to many diseases, more definitive diagnostic methods are needed. Tests for impactology basically identify the location and number of stones in the bile duct, the main methods are ultrasound scan (MRCP is the main non-invasive test) (transendoscopic retrograde cholangiopancreatography): this can detect and in most cases remove stones Treatment: Patients who present or have had abdominal pain or other symptoms need further treatment. After ERCP, laparoscopic cholecystectomy is usually required after 1 to 2 months (if successful, only 3 to 4 scars of about 1 cm are left in the abdomen). A small percentage of patients require open surgery. (Patients whose stones cannot be successfully removed by ERCP or whose gallbladder cannot be successfully removed by laparoscopy) Some patients with common bile duct stones require placement of a biliary stent, which is placed mainly in the bile duct (part of it may go into the liver) to reduce the high pressure in the bile duct due to obstruction. However, after the patient has improved, the stent can be removed for further stone management if the patient is physically able to do so. Prevention: Limit fat and cholesterol intake Do not go on sudden diets and lose weight quickly Maintain a healthy weight Home care: Take appropriate painkillers for pain if symptoms occur If you have had similar symptoms then you need to reduce fat and cholesterol intake and eat less meat Go to the hospital for further examination and treatment If you have already undergone surgery, take care of the patient according to the doctor’s orders Tips If you have clearly existing bile duct stones, you need to go to the hospital for further treatment when the frequency of pain increases or affects your daily life. If the pain persists for a long time without relief (greater than 5 hours), you have fever, nausea, vomiting, yellowing of the skin, eyes and urine, and lightening of the color of the discriminations, then you need emergency medical treatment.