Chapter 18: Gall Bladder Flashcards
What is the most common congenital anomaly of the gallbladder?
Inward folded fundus –> Phrygian cap
Why is estrogen exposure a risk factor for the development of gallstones?
Because of this who is at the most risk?
- Increases expression of: hepatic lipoprotein receptors and hepatic HMG-CoA reductase activity —> enhanced cholesterol uptake and biosynthesis
- Females taking OCs and during pregnancy
Rates of cholesteorl gallstones approach 75% in persons of which cultural group?
Native Americans of the Pima, Hopi, and Navajo groups
Which specific gene and transporter have been implicated in the development of cholesterol gallstones?
- ABCG8 gene
- ATP-binding casette (ABC) transporters
Pigment stones are more commonly seen in the setting of which 3 GI disorders?
- Ileal disease (i.e., Chron disease)
- Ileal resection or bypass
- CF w/ pancreatic insufficiency
Which 4 conditions contribute to the formation of cholesterol gallstones?
1) Supersaturation of bile w/ cholesterol
2) Hypomobility of gallbladder
3) Accelerated cholesterol crystal nucleation
4) Hypersecretion of mucus in the GB –> traps nucleated crystals –> addition of more cholesterol –> stones
The development of pigment stones is associated with disorders that cause an increase in what?
List some of these disorders
- Unconjugated bilirubin
- Chronic hemolytic anemias
- Severe ileal dysfunction or bypass
- Bacterial contamination of the biliary tree
Infection of the biliary tree leads to the release of which enzyme that hydrolyzes bilirubin glucuronides?
microbial β-glucuronidases
Infection of the biliary tree by which 3 organisms increase the risk of developing pigment stones?
- E. coli
- Ascaris lumbricides = roundworm (intestinal nematode)
- Liver fluke -> C. sinensis
In general, where are black pigmented stones vs. brown pigmented stones found?
- Black are found in STERILE gallbladder bile
- Brown are found in INFECTED large bile ducts
Can black and brown pigmented stones be seen on X-ray?
- Majority of black stones are radiopaque = can see on XR (due to calcium salts)
- Brown stones are radiolucent (can’t be seen) due to calcium soaps
When symptomatic, gallstones typically produce what type of pain, which radiates where?
Commonly presents after the patient does what?
- Biliary colic that may be excruciating and is typically constant
- Pain is localized to RUQ or epigastrium that may radiate to the right shoulder or the back
- Pain typically follows a fatty meal
How does the size of the gallstone relate to the likelihood of it causing problems?
- Larger the calculi, the less likely they are to enter the cystic or common ducts to produce obstruction
- Very small stones, or “gravel,” are far more dangerous
What are complications that may arise sometimes with large gallstones?
- May erode directly into an adjacent loop of small bowel, generating an intestinal obstruction
- “Gallstone ileus” or “Bouveret syndrome”
Acute calculous cholecystitis is typically caused by an obstruction of which 2 areas by a stone?
Neck or cystic duct
What is the primary complication of gallstones and the most common reason for emergency cholecystectomy?
Acute Cholecystitis
How do bacterial infections contribute to the initiating events of Acute Calculous Cholecystitis?
These events occur in the absence of bacterial infections; only later in the course may a bacterial infection occur
Patients with which metabolic disorder + symptomatic gallstones frequently develop acute calculous cholecystitis?
Diabetes mellitus
Acute acalculous cholecystitis, without stone involvement, is thought to result from what?
Ischemia
Which artery is implicated in Acute Acalculous Cholecystitis?
Cystic artery = end artery w/ no collateral circulation
Acute Acalculous Cholecystitis most frequently occurs in patients who are hospitalized for unrelated conditions, such as (list 5 common settings)?
- Sepsis w/ hypotension and multisystem organ failure
- Immunosuppression
- Major trauma and burns
- Diabetes mellitus
- Infections
When the exudate inside the gallbladder lumen is virtually pure pus, the condition is referred to as?
Gallbladder empyema
In the acute cholecystitis, the GB is typicall enlarged and the serosal covering is frequently covered by what type of exudate?
Fibrinopurulent exudate
In severe cases of acute cholecystitis the GB may be transformed into a green-black necrotic organ w/ small-to-large perforations and this condition is known as?
Gangrenous cholecystitis
