Biliary Microlithiasis

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Biliary Microlithiasis - RUQ Pain

Intermittent RUQ pain could result from temporary obstruction in the cystic duct or ampulla. Foci may cause intermittent RUQ pain and they occur with and without gallstones. Foci could obstruct in the cystic duct or ampulla, pressure builds behind the obstruction causing pain by distending the CBD and/or gallbladder. Pressure exceeds a critical point and the foci or the impacted mass of foci is disrupted with pain relief. Three children 3-4 years old with foci were colicky as babies and presented with evidence of intermittent abdominal pain based on episodic crying. Should undiagnosed colicky babies have rotational ultrasound for foci? Foci are common in the pediatric age group. Sudden moderate constant undiagnosed upper abdominal pain, with or without prior intermittent RUQ pain, could be near complete obstruction in the ampulla or cystic duct or it could be minor pancreatitis caused by foci. Foci may cause "the same" RUQ pain post cholecystectomy as they form and pass through the cystic duct remnant propelled by contractions and secretions in the cystic duct remnant. Temporary obstruction by foci in the ampulla may cause "the same" pain post cholecystectomy. Future gallbladder ultrasound using this rotation technique with gallstones could predict with the view to prevent "the same pain" post cholecystectomy. Cholecystectomy should cure the pain of gallstones if there are no foci. Asymptomatic patients with foci may have smaller foci relative to the size of the cystic duct and ampulla but might have the same risk of pancreatitis or elevated liver enzymes.

We suspect the pain of biliary dysfunction (eg: sphincter of Odi dysfunction) may be due to these foci.