B5.022 Cholecystitis and Cholelithiasis

Question 1

Coombs test

Answer 1

used to evaluate hemolytic anemia

condition of low red blood cells caused by immune system lysis or breakdown of RBC membranes

Question 2

spherocytosis

Answer 2

auto-hemolytic anemia characterized by the production of spherocytes (RBCs that are sphere shaped rather than biconvave disk shaped)

Question 3

what type of stones present in those with hemolytic anemia?

Answer 3

black pigmented stones

calcium bilirubinate

Question 4

outcomes of hereditary spherocytosis

Answer 4

recurrent extravascular hemolysis of fragile RBCs within the spleen
leads to increased bilirubin and formation of calcium bilirubinate gallstones, predisposing to cholecystitis

Question 5

additional findings with hereditary spherocytosis

Answer 5

increased red cell distribution

increased reticulocyte count

Question 6

splenectomy as a treatment for hereditary spherocytosis

Answer 6

can prevent the destruction and removal of spherocytes, thereby preventing development of gallstones

Question 7

what can cause jaundice in a 2 week old baby?

Answer 7

increased B glucuronidase activity, which promotes enterohepatic circulation of bilirubin

Question 8

breast milk jaundice

Answer 8

indirect hyperbilirubinemia and moderate jaundice

make sure to identify absence of dehydration or anemia

Question 9

physiological neonatal jaundice

Answer 9

common in term and preterm neonates
3rd-8th day of life
indirect hyperbilirubinemia <9 without other concerning signs or symptoms

Question 10

biliary atresia

Answer 10

direct hyperbilirubinemia
normal development for first two weeks of life
jaundice, hepatosplenomegaly, early cirrhosis soon after

Question 11

crigler najjar type 1

Answer 11

indirect hyperbilirubinemia
absent UDP1A1 activity
excessive neonatal jaundice (20-50 mg/dL)
absent conjugated bilirubin
neurological symptoms

Question 12

give an overview of heme metabolism

Answer 12

heme released from old RBCs
macrophages engulf residual heme
converted to biliverdin then bilirubin
bilirubin conjugated in liver by UGT1A1

Question 13

distended gallbladder, thickened gallbladder wall, pericholecystic fluid, no stones

Answer 13

acute acalculous cholecystitis

Question 14

what is AAC

Answer 14

inflammatory disease of the gallbladder without evidence of gallstones or cystic duct obstruction
severe illness that is a complication of various other medical conditions

Question 15

illnesses associated with direct hyperbilirubinemia

Answer 15

dubin Johnson

rotor

Question 16

illnesses associated with indirect hyperbilirubinemia

Answer 16

hemolysis
drugs
gilberts syndrome
crigler najjar
neonatal