Choledocholithiasis<unk> s in<unk> <unk> <unk>  is one of the complications of cholelithiasis (gallstones), so the initial step is to confirm the diagnosis of cholelithiasis. Patients with cholelithiasis typically present with pain in the right-upper quadrant of the abdomen with the associated symptoms of nausea and vomiting, especially after a fatty meal. The physician can confirm the diagnosis of cholelithiasis with an abdominal ultrasound that shows the ultrasonic shadows of the<unk> s in the gallbladder. The diagnosis of choledocholithiasis is suggested when the liver function blood test shows an elevation in bilirubin and serum transaminases. Other indicators include raised indicators of ampulla of vater (pancreatic<unk>  obstruction) such as lipases and amylases. In prolonged cases the international normalized ratio (INR) may change due to a decrease in vitamin K absorption. (It is the decreased<unk>  flow which reduces fat breakdown and therefore absorption of fat soluble vitamins). The diagnosis is confirmed with either a magnetic resonance cholangiopancreatography (MRCP), an endoscopic retrograde cholangiopancreatography (ERCP), or an intraoperative cholangiogram. If the patient must have the gallbladder removed for gallstones, the surgeon may choose to proceed with the surgery, and obtain a cholangiogram during the surgery. If the cholangiogram shows a<unk>  in the<unk> <unk> , the surgeon may attempt to treat the problem by flushing the<unk>  into the intestine or retrieve the<unk>  back through the cystic<unk> . On a different pathway, the physician may choose to proceed with ERCP before surgery. The benefit of ERCP is that it can be utilized not just to diagnose, but also to treat the problem. During ERCP the endoscopist may surgically widen the opening into the<unk> <unk>  and remove the<unk>  through that opening. ERCP, however, is an invasive procedure and has its own potential complications. Thus, if the suspicion is low, the physician may choose to confirm the diagnosis with MRCP, a non-invasive imaging technique, before proceeding with ERCP or surgery. File:Impacted ampulla.Common<unk> <unk><unk>  impacted at ampulla of Vater seen at time of endoscopic retrograde cholangiopancreatography (ERCP) File:Ultrasonography of<unk> , with arrow.Abdominal ultrasonography of a<unk>  File:ERCP Roentgen.Fluoroscopic image taken during endoscopic retrograde cholangiopancreatography (ERCP). Multiple gallstones are present in the gallbladder and cystic<unk> . The<unk> <unk> <unk>  and pancreatic<unk>  appear to be unobstructed.
Common bile duct stone
Hepatolithiasis
Biliary pseudolithiasis
Porcelain gallbladder
Gallbladder polyp
Biliary microlithiasis
Cholesterolosis of gallbladder
Biliary sludge