11.2 - Gallbladder and Biliary Tract

Question 1

biliary atresia

• what happens?
• when presents?
• what is patient presentation?

Answer 1

• failure to form or early destruction of extrahepatic biliary tree
• biliary obstruction within first 3 months
• neonatal jaundice (CB) –> cirrhosis (back pressure into liver)

Question 2

What is cholelithiasis?

Answer 2

solid, round stones in gallbladder

Question 3

Cause of cholelithiasis?

Answer 3

precipitation of cholesterol or bilirubin in bile

• supersaturation (high concentration of cholesterol or bilirubin)
• dec phospholipids or bile acids (these 2 compounds solubolize certain things in “bile” like cholesterol and bilirubin so if they are gone = more precipitation = stone)
• stasis

Question 4

How do gallstone appear on x-ray?

Answer 4

Radiolucent! - do not show up on x-ray!

Question 5

Risk factors for cholesthiasis?

Answer 5

• age
• estrogen (females–increase activity of HMG-CoA synthase = more cholesterol)
• clofibrate (drug-lipid lowering agent - increase HMA-CoA activity & dec conversion of chol to bile acids)
• Native American
• CD - affects terminal ileum - less uptake of bile acids and salts = less solubilization
• cirrhosis - cant solubilize bc cant make with damaged liver

Question 6

How do bilirubin stones appear on x-ray?

Answer 6

radiopaque! SHOW ON X-ray

Question 7

Risk factors for bilirubin stones?

Answer 7

• extravascular hemolysis

- biliary tract infection (E Coli, Ascaris lumbricoides, clonorchis sinesis)

Question 8

Complications of gallstones:

Answer 8

• biliary colic
• acute and chronic cholecystitis
• ascending cholangitis
• gallstone ileus
• gallbladder cancer

Question 9

Biliary colic

• patient presentation
• due to what?

Answer 9

• waxing and waning RUQ pain

- due to gallbladder contracting against stone lodged in cystic duct

Question 10

Acute cholecystitis

• what is it?
• how happens?

Answer 10

• acute inflammation of gallbladder wall
• blockage of cystic duct –> dilation of gallbladder and buildup of pressure –> pressure ischemia ==> bacterial overgrowth and inflammation

Question 11

Acute cholecystitis

• classic presentation?
• other pt symptoms?

Answer 11

-RUQ pain radiating to RIGHT SCAPULA*
OTHER:
-fever with inc WBC
-nausea
-vomit
-INC serum AK

Question 12

What is chronic cholecystitis due to?

Answer 12

chemical irritation from longstanding cholelithiasis

Question 13

Rokitanky-Aschoff sinus formation

• happens in what disease?
• what is it?

Answer 13

• chronic cholecystitis

- gallbladder mucosa outpouches down into smoothmuscle = histology

Question 14

Chronic cholecystitis

• presentation
• what is a late complication?

Answer 14

• VAGUE RUQ pain especially after eating

- porcelain gallbladder (calcified wall of gallbladder on X-ray) = late complication

Question 15

Tx for chronic cholecystitis?

Answer 15

-cholecystectomy and ESPECIALLY remove if porcelain gallbladder is present (risk for gallbladder cancer

Question 16

Ascending cholangitis

• what happens? due to?
• What condition increases occurrence?

Answer 16

• bacterial infection of bile ducts - usually due to ascending infection with enteric GNB
• choledolithiasis - stone in the duct slows down bile flow = the bacteria can get up duct easier

Question 17

Ascending cholangitis presentation?

Answer 17

• sepsis
• jaundice
• abdominal pain

Question 18

Gallstone ileus

-what happens? due to?

Answer 18

• stone enters and obstruct the small bowel

- due to cholecystitis with fistula formation between gallbladder and small bowel

Question 19

Gallbladder carcinoma

• what kind of cancer? what tissue?
• risk factors?
• classic patient/presentation?

Answer 19

• adenocarcinoma - from glandular epithelium that lines the gallbladder wall
• gallstone (especially if with porcelain gallbladder)
• classically cholecystitis in an elderly woman

-poor prognosis