2 Gallbladder, Biliary Tract

Question 1

gallstone ileus

Answer 1

-fistula from GB to intestine can result in large stones entering and obstructing intestine

Question 1

gallbladder carcinoma

• what type of cell
• biggest risk factor
• classic presentation, population

Answer 1

• adenocarcinoma, from glandular epithelium of GB wall
• gallstones
• classically cholecystitis in elderly woman (usu cholecystitis presents in middle age)

Question 2

ascending cholangitis

• cause
• clinical presentation (3)

Answer 2

• bacterial infection of ducts
• more likely with stone–blocks bile blow that flushes bacteria
  1. sepsis
  2. jaundice
  3. abdominal pain

Question 4

Biliary atresia

-clinical presentation, what age?

Answer 4

• failure to form extrahepatic biliary tree
• biliary obstruction, 1st 2 months of life
• jaundice, progresses to cirrhosis!

Question 5

How does cholestyramine cause gallstones?

-what type of gallstones?

Answer 5

Side effect.

-cholestyramine binds bile acids so they won’t reeneter circulation. Bile acids required to maintain solubility of cholesterol in bile. So, cholesterol stones can form

Question 5

chronic cholecystitis

• causes
• specific mech
• clinical symptoms

Answer 5

• chronic inflamm of GB from longstanding cholelithiasis
• Rokitansky-Aschoff sinus: herniation of GB mucosa into muscular wall
• vague RUQ pain, esp after eating

Question 6

cholelithiasis

• mech (3)
• divided into what 2 types

Answer 6

• precipitation of cholestrol or bilirubin
  1. supersaturation of cholesterol/bilirubin
  2. decreased phosopholipids or bile acids (increase solubility)
  3. stasis–bacteria can deconjugate bilirubin, leading to bilirubin stones
  1. cholesterol
  2. bilirubin

Question 6

Biliary colic

-mech

Answer 6

• waxing/waning of RUQ pain
• due to GB contracting against stone lodged in cystic duct
• common bile duct obstruction can result in acute pancreatitis or obstructive jaundice

Question 8

bilirubin gallstones

• radiolucent?
• color
• risk factors (2)

Answer 8

• usu radiopaque, pigmented (not yellow like cholesterol)
  1. extravascular hemolysis
  2. biliary tract infection (eg ascaris lumbricoides roundworm, clonorchis sinesis Chinese liver fluke)

Question 10

acute cholecystitis

• cause, mech
• clinical symptoms (pattern of pain?)
• what blood level is abnormal?
• risk of what late complication

Answer 10

• acute inflamm of gallbladder wall
• caused by cystic duct stone, with bacterial overgrowth (e coli)
• RUQ pain, radiates to right scapula.
• fever, nausea, vomiting
• elevated ALP from duct damage
• risk of rupture

Question 11

chronic cholecystitis

• late complications (2)
• tx

Answer 11

1. porcelain GB (shrunken, fibrosis, calcification)
2. increased risk for carcinoma
   - remove GB if procelain. (higher risk for carcinoma)

Question 12

Gallstones

-symptoms

Answer 12

• usu asymptomatic
• biliary colic
• acute/chronic cholecystitis
• ascending cholangitis
• gallstone ileus
• gallbladder cancer

Question 13

Your pt is a 70 year old woman who presents with new onset of cholecystitis. Suspect what?

Answer 13

suspect GB carcinoma.

-cholecystitis usu presents in middle age, not elderly

Question 14

cholesterol gallstones

• radiolucent?
• color
• risk factors

Answer 14

• usu radiolucent, yellow.
• age-40s, estrogen, clofibrate, native american, crohn’s disease (no ileal uptake of bile acids), cirrhosis (low bile salt production for solubility)