Chapter 18-Gallbladder Flashcards

1
Q

What is the most common gallbladder anomaly

A

Phrygian cap

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2
Q

Pigmented stones are composed of what

A

Bilirubin calcium salts

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3
Q

Cholesterol stones are composed of what

A

Crystalline cholesterol mono hydrate

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4
Q

Which areas of the world are more prone to gallstones

A

US and Western Europe

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5
Q

Which patient populations are at a higher risk for gallstones

A

Native Americans

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6
Q

What is the primary form of gallstones in the nondeveloped world and what is there cause

A

Pigmented stones, usually doe to a bacterial infection of the biliary tree

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7
Q

Which age and sex are more likely to develop gallstones

A

White women

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8
Q

Which environmental factors increase the risk fo gallstones

A

-Pregnancy, oral contraceptives, estrogen

Increases HMG-COA reductase activity

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9
Q

Which genetic factor is associated with higher rates of gallstones

A

ABC protein G8 (ABCG8)

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10
Q

What four biochemical situations cause the formation of gallstones

A

1-supersaturation of bile with cholesterol
2- hypomotility of the gallbladder
3- accelerated cholesterol crystal nucleation
4- hyper-secretion of mucus

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11
Q

Which condition cause the increased changes of pigmented stones

A

1-elevated unconjugated-bilirubin
2-chronic hemolytic anemia
3-ileal dysfunction
4-bacterial infection

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12
Q

How does infection lead to increased rates of pigmented stone

A

Bacterial enzyme Beta-glucuronidases converts and hydrolyzes bilirubin glucoronides

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13
Q

Infection with which organisms leads to pigmented stones

A
  • E.Coli
  • Ascaris lumbricoides
  • liver fluke C.sinensis
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14
Q

What are the clinical presentions of gallstones

A

Most asymptomatic, but upon a fatty meal RUQ pain develops

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15
Q

Which size of gallstones are likely to cause obstruction and pain

A

The small ones, as the large ones will not be able to get into the ducts

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16
Q

What is the condition Bouveret syndrome

A

Aka gallstones lieus

Large stones may erode directly into an adjacent loop of small bowel

17
Q

Which cancer are gallstones associated with

A

Higher risk for gallbladder carcinoma

18
Q

Acute calculus cholecystitis is most commonly caused by obstruction of which ducts and what percentage

A

90% are obstruction of the neck or cystic duct by a stone

19
Q

Which condition may exacerbate acute calculous cholecystitis

A

DM who have symptomatic gallstones

20
Q

What are the conditions that can cause acute acalculous cholecystitis that do not involve a stone

A

Ischemia of gallbladder via the cystic artery:

  • sepsis with Hypotensive organ failure
  • immunosupression
  • major trauma/burns
  • DM
  • Infection
21
Q

What is the condition of gallbladder empyema

A

When the exudate of the gallbladder is pure pus

22
Q

Which form of acute cholecystitis is more emergent of a situation

A

Acalculous, as gangrene is much higher

23
Q

Which bacteria can infect the gallbladder and cause acute acalculous cholecystitis

A

Staph and salmonella typhi

24
Q

What are Rokitansky-Aschoff sinuses and which condition are they seen in

A

Chronic cholecystitis and they are outpouching of the mucosal epithelium through the wall

25
What condition is porcelain gallbladder associated with
Cancers
26
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
27
What is the condition of hydrops of the gall bladder
Atropic, chronically obstructed, dilated gallbladder that only contains clear secretions
28
What is the most common malignancy of the extrahepatic biliary tract
Carcinoma
29
Which patient populations have a higher risk for gallbladder carcinoma
Native Americans and Hispanics
30
Which gender is more likely to get gallbladder carcinoma
Women
31
What is the most important risk factor for gallbladder cancer
Gallstones
32
In gallbladder cancer, which gene is commonly upregulated
ERBB2 (Her-2)
33
Which form of gallbladder carcinomas is most common
Infiltrating
34
Most carcinomas of the gallbladder are what kind of origin
Adenocarcinoma
35
Which form of gallbladder carcinomas have a better prognosis
Papillary tumors
36
What are the common sites of seeding as a result of gallbladder cancer
Peritoneum, GI, Lungs