"Intrahepatic bile duct stones"

Written by Zhang Tao
Hepatobiliary Surgery
Updated on September 04, 2024
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Intrahepatic bile duct stones, as the name implies, are stones located within the bile ducts inside the liver. The biliary tract is divided into extrahepatic and intrahepatic bile ducts. The intrahepatic bile ducts refer to the left and right hepatic ducts and their related branches. The intrahepatic bile ducts evolve from the left and right hepatic ducts into the common hepatic duct, common bile duct, and gallbladder, which are part of what we commonly refer to as the extrahepatic bile ducts. The symptoms of intrahepatic bile duct stones are not as apparent as those of common bile duct stones, but most intrahepatic bile duct stones cause upper abdominal pain in patients; generally, jaundice does not occur.

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Ultrasound presentation of intrahepatic bile duct stones

Intrahepatic bile duct stones can generally be detected via ultrasound, as they show up as strong echoes due to their solid nature which reflects sound waves back to the surface. However, the majority of these intrahepatic bile duct stones are asymptomatic. Since they rarely cause dilation of the intrahepatic bile ducts, and as long as the bile ducts do not appear dilated, thickened, or tortuous on the ultrasound, they usually do not have any significant impact. Therefore, most intrahepatic bile duct stones do not require treatment and can be managed through observation.

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Will intrahepatic bile duct stones cause a bluish complexion?

Patients with intrahepatic bile duct stones, if experiencing an episode, may exhibit symptoms such as sharp pain in the upper right abdomen, often accompanied by nausea, vomiting, abdominal bloating, and diarrhea. These patients are prone to acute cholangitis. Additionally, this condition is a type of biliary colic, thus the pain is significant and may even manifest as a bluish complexion. Therefore, patients with prominent symptoms should undergo surgery as soon as possible. Surgery is the only definitive treatment. Although the use of antibiotics for infection control can alleviate the inflammation and improve the condition temporarily, recurrence is common.

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Written by Zhang Tao
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How is intrahepatic bile duct stones treated?

Intrahepatic bile duct stones refer to stones located in the branches of the bile duct above the junction of the left and right hepatic ducts. Surgical treatment is currently the main method of treatment. Treatment should be based on the number and distribution of stones within the bile ducts, the location and extent of hepatic and biliary strictures, pathological changes in the liver, the state of liver function, and the patient's overall symptoms. Appropriate surgical approaches should be adopted, including hepatectomy, high position bile ductotomy for stone removal, transhepatic choledochotomy for stone removal, biliary-intestinal internal drainage, liver transplantation, etc.

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Is the incidence of intrahepatic bile duct stones high?

Intrahepatic bile duct stones have a relatively low incidence rate. They are a type of gallstone, and compared to gallbladder stones, their occurrence is less frequent. Patients with intrahepatic bile duct stones often experience concurrent cholangitis, leading to symptoms such as upper abdominal pain, significant nausea, and vomiting, along with other gastrointestinal symptoms. Therefore, for patients with intrahepatic bile duct stones, when significant symptoms occur, not only is the use of antibiotics necessary to treat the infection and control the inflammation, but surgery is also required to achieve therapeutic effects. The primary surgical method is choledochotomy for stone removal, which can lead to better treatment outcomes after the stones are extracted.

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Is the recurrence rate of intrahepatic bile duct stones high?

Intrahepatic bile duct stones can potentially recur. Intrahepatic bile duct stones are often accompanied by acute cholangitis, resulting in significant right upper abdominal pain, and may also present with nausea, vomiting, abdominal distension, diarrhea, and other gastrointestinal symptoms. When symptoms occur, surgery can be performed to open the bile duct and remove the stones for a radical cure. However, there is also a possibility of recurrence in postoperative patients. The likelihood of recurrence cannot be definitively determined but should be assessed based on the condition of the illness. Therefore, patients who have undergone surgery should also have regular ultrasonographic follow-ups to dynamically observe changes in their condition and prevent the worsening of the disease.