Chapter 14: The Gallbladder

Question 1

What is the name for congenital bile duct dilations?

Answer 1

Choledochal cysts

Choledochal diverticula

Choledochoceles

Multiple cysts

Caroli disease

Question 2

What substances compose gallstones (cholelithisasis?_

Answer 2

Cholesterol, calcium bilirubinate, other calcium salts (pigment gallstones).

Pigment stones are black.

Below are yellow cholesterol gallstones.

Estrogen increases cholesterol secretion and decresaes bile salt secretion

Progesterone slows gallbladder emptying.

Question 3

What factors predispose to pigment gallstones?

Answer 3

Chronic hemolysis (sickle cell anemia, thallassemia). Cirrhosis. Calcium bilirubinate, bilirubin polymers, calcium salts, mucin.

Question 4

What are brown pigment gallstones made of, and wherea re they found?

Answer 4

Spingy and laminated. Calcium bilirubinate mixed with cholesterol and calcium soaps of fatty acids.

Intrahepatic and extrahepatic bile ducts.

Almost always associated with bacterial cholangitis - E. coli.

Question 5

A gallbladder is found to be enlarged. It is removed and examined.

Answer 5

Hydrops of the gallbladder. Found when cystic duct is occluded - bile reabsorbed and replaced with mucin.

Question 6

A patient presents with RUQ pain and a history of gallstones. The gallbladder is removed and its external surface is congested and layered with a fibrinous exudate.

Answer 6

Acute cholecystitis.

Empyema of the gallbladder: Cystic duct completely occluded, bacteria invade gallbladder, cavity distended by cloudy purulent fluid.

Question 7

A patient presents with RUQ pain and a history of gallstones. The gallbladder is removed and upon examination it is thickened and firm.

Answer 7

Chronic cholecystitis

Fibrotic wall may be penetrated by sinuses of Rokitansky-Aschoff.

Calcification called porcelain gallbladder.

Question 8

Gallbladder is found with accumulation of cholesterol-laden macrophages within the submucosa.

Answer 8

Cholesterolosis. Due to supersaturation of bile with cholesterol - usually asymptomatic.

Mucosa with scattered yellow flecks and mucosal folds, swollen with large foamy macrophages.

Question 9

What are some benign tumors of the gallbladder?

Answer 9

Papillomas - associated with gallstones

Adenomyoma: Adenoma and smooth muscle

Fibromas, lipomas, leiomyomas, myxomas recorded.

May occlude bile ducts - obstruct biliary flow, cause jaundice.

Question 10

An incidental finding on gallbladder removal - exophytic growth into the lumen. Gallbladder wall thickened and leathery.

Answer 10

Adenocarcinoma of the gallbladder.

Predisposed with cholelithiasis and calcified gallbladders

Cancers of extrahepatic bile ducts almost always adenocarcinoma.