Chapter 18-Gallbladder Flashcards
What is the most common gallbladder anomaly
Phrygian cap
Pigmented stones are composed of what
Bilirubin calcium salts
Cholesterol stones are composed of what
Crystalline cholesterol mono hydrate
Which areas of the world are more prone to gallstones
US and Western Europe
Which patient populations are at a higher risk for gallstones
Native Americans
What is the primary form of gallstones in the nondeveloped world and what is there cause
Pigmented stones, usually doe to a bacterial infection of the biliary tree
Which age and sex are more likely to develop gallstones
White women
Which environmental factors increase the risk fo gallstones
-Pregnancy, oral contraceptives, estrogen
Increases HMG-COA reductase activity
Which genetic factor is associated with higher rates of gallstones
ABC protein G8 (ABCG8)
What four biochemical situations cause the formation of gallstones
1-supersaturation of bile with cholesterol
2- hypomotility of the gallbladder
3- accelerated cholesterol crystal nucleation
4- hyper-secretion of mucus
Which condition cause the increased changes of pigmented stones
1-elevated unconjugated-bilirubin
2-chronic hemolytic anemia
3-ileal dysfunction
4-bacterial infection
How does infection lead to increased rates of pigmented stone
Bacterial enzyme Beta-glucuronidases converts and hydrolyzes bilirubin glucoronides
Infection with which organisms leads to pigmented stones
- E.Coli
- Ascaris lumbricoides
- liver fluke C.sinensis
What are the clinical presentions of gallstones
Most asymptomatic, but upon a fatty meal RUQ pain develops
Which size of gallstones are likely to cause obstruction and pain
The small ones, as the large ones will not be able to get into the ducts
What is the condition Bouveret syndrome
Aka gallstones lieus
Large stones may erode directly into an adjacent loop of small bowel
Which cancer are gallstones associated with
Higher risk for gallbladder carcinoma
Acute calculus cholecystitis is most commonly caused by obstruction of which ducts and what percentage
90% are obstruction of the neck or cystic duct by a stone
Which condition may exacerbate acute calculous cholecystitis
DM who have symptomatic gallstones
What are the conditions that can cause acute acalculous cholecystitis that do not involve a stone
Ischemia of gallbladder via the cystic artery:
- sepsis with Hypotensive organ failure
- immunosupression
- major trauma/burns
- DM
- Infection
What is the condition of gallbladder empyema
When the exudate of the gallbladder is pure pus
Which form of acute cholecystitis is more emergent of a situation
Acalculous, as gangrene is much higher
Which bacteria can infect the gallbladder and cause acute acalculous cholecystitis
Staph and salmonella typhi
What are Rokitansky-Aschoff sinuses and which condition are they seen in
Chronic cholecystitis and they are outpouching of the mucosal epithelium through the wall
What condition is porcelain gallbladder associated with
Cancers
What is xanthogranulomatous cholecystitis and what is the triggering event
Gallbladder has a massive thickened wall with chronically inflamed necrosis and hemorrhage. This is triggered by rupture of Rokitansky-Aschoff sinuses and results from the accumulation of macrophages that have become xanthomas cells as a result of engulfment of lipids
What is the condition of hydrops of the gall bladder
Atropic, chronically obstructed, dilated gallbladder that only contains clear secretions
What is the most common malignancy of the extrahepatic biliary tract
Carcinoma
Which patient populations have a higher risk for gallbladder carcinoma
Native Americans and Hispanics
Which gender is more likely to get gallbladder carcinoma
Women
What is the most important risk factor for gallbladder cancer
Gallstones
In gallbladder cancer, which gene is commonly upregulated
ERBB2 (Her-2)
Which form of gallbladder carcinomas is most common
Infiltrating
Most carcinomas of the gallbladder are what kind of origin
Adenocarcinoma
Which form of gallbladder carcinomas have a better prognosis
Papillary tumors
What are the common sites of seeding as a result of gallbladder cancer
Peritoneum, GI, Lungs
