CBD stone may present with -

Ans. (a) Increased bilirubin; (b) T WBC count ; (c) T liver enzymes Clinical presentation of a CBD stone may remain silent biliary colic (abd. pain is usually intermittent and often associated with nausea & vomitting (with rigors) cholangitis - may present with fever, pain or jaundice or pancreatitis Laboratory findings - due to biliary obstruction T serum alkaline phosphatase T serum gamma glutamyl transpeptidase T serum bilirubin mildly elevated SGOT & SGPT (AST & ALT) if cholangitis is associated T WBC count markedly elevated SGOT & SGPT Also know CBD stones can be of two types a) Secondary - formed within the gall bladder and migrate down the cystic duct to CBD more common type - usually are cholesterol stones b) Primary formed per primam in the CBD usually of the brown pigment type the surgical significance of primary CBD stone is that they are the product of two conditions that must be corrected in treating these stones i) bile duct stasis and ii) infection