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(OMS2) GI II Exam 2 > Chapter 18: Gall Bladder > Flashcards

Chapter 18: Gall Bladder Flashcards

1
Q

What is the most common congenital anomaly of the gallbladder?

A

Inward folded fundus –> Phrygian cap

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2
Q

Why is estrogen exposure a risk factor for the development of gallstones?

Because of this who is at the most risk?

A
  • Increases expression of: hepatic lipoprotein receptors and hepatic HMG-CoA reductase activity —> enhanced cholesterol uptake and biosynthesis
  • Females taking OCs and during pregnancy
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3
Q

Rates of cholesteorl gallstones approach 75% in persons of which cultural group?

A

Native Americans of the Pima, Hopi, and Navajo groups

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4
Q

Which specific gene and transporter have been implicated in the development of cholesterol gallstones?

A
  • ABCG8 gene
  • ATP-binding casette (ABC) transporters
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5
Q

Pigment stones are more commonly seen in the setting of which 3 GI disorders?

A
  • Ileal disease (i.e., Chron disease)
  • Ileal resection or bypass
  • CF w/ pancreatic insufficiency
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6
Q

Which 4 conditions contribute to the formation of cholesterol gallstones?

A

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

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7
Q

The development of pigment stones is associated with disorders that cause an increase in what?

List some of these disorders

A
  • Unconjugated bilirubin
  • Chronic hemolytic anemias
  • Severe ileal dysfunction or bypass
  • Bacterial contamination of the biliary tree
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8
Q

Infection of the biliary tree leads to the release of which enzyme that hydrolyzes bilirubin glucuronides?

A

microbial β-glucuronidases

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9
Q

Infection of the biliary tree by which 3 organisms increase the risk of developing pigment stones?

A
  1. E. coli
  2. Ascaris lumbricides = roundworm (intestinal nematode)
  3. Liver fluke -> C. sinensis
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10
Q

In general, where are black pigmented stones vs. brown pigmented stones found?

A
  • Black are found in STERILE gallbladder bile
  • Brown are found in INFECTED large bile ducts
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11
Q

Can black and brown pigmented stones be seen on X-ray?

A
  • 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
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12
Q

When symptomatic, gallstones typically produce what type of pain, which radiates where?

Commonly presents after the patient does what?

A
  • 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
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13
Q

How does the size of the gallstone relate to the likelihood of it causing problems?

A
  • 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
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14
Q

What are complications that may arise sometimes with large gallstones?

A
  • May erode directly into an adjacent loop of small bowel, generating an intestinal obstruction
  • “Gallstone ileus” or “Bouveret syndrome”
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15
Q

Acute calculous cholecystitis is typically caused by an obstruction of which 2 areas by a stone?

A

Neck or cystic duct

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16
Q

What is the primary complication of gallstones and the most common reason for emergency cholecystectomy?

A

Acute Cholecystitis

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17
Q

How do bacterial infections contribute to the initiating events of Acute Calculous Cholecystitis?

A

These events occur in the absence of bacterial infections; only later in the course may a bacterial infection occur

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18
Q

Patients with which metabolic disorder + symptomatic gallstones frequently develop acute calculous cholecystitis?

A

Diabetes mellitus

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19
Q

Acute acalculous cholecystitis, without stone involvement, is thought to result from what?

A

Ischemia

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20
Q

Which artery is implicated in Acute Acalculous Cholecystitis?

A

Cystic artery = end artery w/ no collateral circulation

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21
Q

Acute Acalculous Cholecystitis most frequently occurs in patients who are hospitalized for unrelated conditions, such as (list 5 common settings)?

A
  • Sepsis w/ hypotension and multisystem organ failure
  • Immunosuppression
  • Major trauma and burns
  • Diabetes mellitus
  • Infections
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22
Q

When the exudate inside the gallbladder lumen is virtually pure pus, the condition is referred to as?

A

Gallbladder empyema

23
Q

In the acute cholecystitis, the GB is typicall enlarged and the serosal covering is frequently covered by what type of exudate?

A

Fibrinopurulent exudate

24
Q

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?

A

Gangrenous cholecystitis

25
Q

Invasion of the GB w/ gas-forming organisms, such as clostridia and coliforms, may cause a condition known as?

A

Acute “emphysematous” cholecystitis

26
Q

How does acute calculous cholecystitis typically present clinically?

Associated sx’s?

A
  • Progressive RUQ or epigastric pain lasting for >6 hours
  • Associated w/: mild fever, anorexia, tachycardia, sweating, N/V
27
Q

Presence of hyperbilirubinemia/jaundice in a patient presenting w/ suspected acute calculous cholecystitis suggests what kind of obstruction?

A

Obstruction of common bile duct

28
Q

Acute calculous cholecystitis may present with mild to moderate leukocytosis and be accompanied with what serum finding?

A

Mild elevations in alkaline phosphatase

29
Q

In some cases acute calculous cholecystitis may appear with remarkable suddenness and this must be dealt with how in the clinic?

A

Acute surgical emergency

30
Q

The incidence of gangrene and perforation are much higher in which type of acute cholecystitis?

A

Acute acalculous cholecystitis

31
Q

Which 2 organisms can give rise to acute acalculous cholecystitis?

A
  • Salmonella typhi
  • Staphylococci
32
Q

In 90% of cases Chronic Cholecystitis is associated with?

In 33% of cases which 2 organisms may be culutred from the bile?

A
  • 90% of cases = associated w/ cholelithiasis (gallstones)
  • 33% contain E. coli and enterococci
33
Q

In Chronic Cholecystitis the serosa is typically smooth and glistening, but may be dulled by?

A

Subserosal fibrosis

34
Q

Outpuchings of the mucosal epithelium through the wall of the GB may be quite prominent in Chronic Cholecystitis and is known as?

A

Rokitansky-Aschoff sinuses

35
Q

In some cases of Chronic Cholecystitis, extensive dystophic calcification may yield what?

A

Porcelain gallbladder

36
Q

Porcelain gallbladder caused by extensive dystrophic calcification is associated with an increased risk for?

A

Cancer

37
Q

What is seen in Xanthogranulomatous cholecystitis, describe the morphology.

Characteristic cell type?

A
  • GB has massively thickened wall and is shrunken, nodular, and chronically inflammed w/ foci of necrosis + hemorrhage
  • Macrophages w/ ingested biliary phospholipids = foamy cytoplasm = xanthoma cells
38
Q

What triggers xanthogranulomatous cholecystitis?

A

Rupture of Rokitansky-Aschoff sinuses into the wall of the GB –> accumulation of macrophages that have ingested bilirary phospholipids

39
Q

Chronic cholecystitis does not have the striking clinical manifestations of acute forms and is usually characterized by what symptoms?

A
  • Recurrent attacks of either steady epigastric or RUQ pain
  • N/V and intolerance for fatty foods are common findings
40
Q

The diagnosis of both acute and chronic cholecystitis is important to avoid which complications?

A
  • Bacterial superinfections w/ cholangitis or sepsis
  • GB perforation and local abscess formation
  • GB rupture w/ diffuse peritonitis
  • Biliary enteric fistula w/ drainage of bile into adjacent organs –> air and bacteria into biliary tree or gallstone induced intestinal obstruction
  • Aggravation of preexisting med condition
  • Porcelain GB w/ increased risk of cancer
41
Q

What is the most common malignancy of the extrahepatic biliary tree?

A

Carcinoma of the GB

42
Q

Which areas of the world have the highest incidence of GB carcinoma?

Where in the US?

A
  • Chile, Bolivia, and Northern India
  • In the US, the areas w/ highest #’s of Native Americans or Hispanics, such as the SW
43
Q

What is the prognosis of GB carcinoma?

A

5-year survival is 10% = poor

44
Q

What is the major risk factor for carcinoma of the GB; due to?

A

Gallstones —> chronic inflammation

45
Q

Which oncoprotein is often seen overexpressed in carcinoma of the GB?

Also, which chromatin remodeling genes?

A

- ERBB2 (Her-2/neu)

  • Chromatin remodeling genes PBRM1 and MLL3
46
Q

What are the 2 patterns of growth seen in carcinomas of the GB?

Which is most common?

A
  1. Infiltrating = most common
  2. Exophytic
47
Q

What are the morphological characteristics of the more common infiltrating growth pattern seen in carcinoma of the GB?

A
  • Poorly defined area of diffuse mural thickening and induration
  • Deep ulceration –> direct penetration of liver or fistula formation to adjacent viscera
  • Scirrhous w/ firm consistency
48
Q

What are the morphological characteristics of the exophytic growth pattern displayed by some carcinomas of the GB?

A
  • Irregular, CAULIFLOWER mass
  • Invades the underlying wall
49
Q

Most carcinomas of the GB are what type of carcinoma?

A

Adenocarcinomas

50
Q

Carcinomas of the GB of which type generally have a better prognosis?

A

Papillary tumors

51
Q

Where are the most common sites for seeding by carcinomas of the GB?

A
  • Liver –> extension into cytic duct and adjacent bile ducts
  • Peritoneum
  • GI tract
  • Lungs
52
Q

Why are carcinomas of the GB typically of poor prognosis?

A
  • Typically are detected late
  • Presenting sx’s are indistinguishable from those associated with cholelithiasis
53
Q

What are 3 major risk factors/underlying diseases that cause pigment stones?

A

1) Chronic hemolytic syndromes
2) Biliary infection
3) GI disorders –> ileal disease (Chron), ileal resection or pass; CF w/ pancreatic insufficiency

(OMS2) GI II Exam 2 (13 decks)

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