Cholecystitis Flashcards
Flow of Bile
(a) Bile is made in the _____
(b) Bile is stored in the ____
(c) Bile is ejected from the gallbladder into the _____ duct in response to fat entering the proximal small intestine.
(d) Bile flows from the cystic duct into the ______ duct.
(e) Bile then flows from the common bile duct into the ______
(f) Bile works in the proximal small intestine (duodenum) to emulsify fats which aids in fatty acid digestion and is eventually reabsorbed into circulation in the terminal ilium
(distal small intestine).
a) Liver
b) gallbladder
c) cystic duct
d) common bile duct
e) duodenum
Bile is useful in what?
the emulsification of fats
Bile is composed of two main components:
1) Bile salts
2) Cholesterol and Bilirubin
There are two major types of gallstones:
Cholesterol gallstones
Pigmented Gallstones
What is the most common form of gallstones
-form when cholesterol in the circulation is increased.
Common situations
(1 Increased estrogen states such as pregnancy
(a Estrogen causes increases in cholesterol levels
(2 Increased total circulating cholesterol
(a Poor diet (diets high in trans and saturated fat)
(b Rapid weight loss
(c Fatty acids that are typically stored in fat cells are mobilized for
digestion via cholesterol.
Cholesterol gallstones
What type of gall stones are formed by the precipitation of bilirubin, a
metabolite of hemoglobin. Are not very common
Pigmented Gallstones
True/FAlse
If the amount of cholesterol or bilirubin present in the gallbladder exceeds the amount of bile salts needed to dissolve it, precipitates (stones) form.
True
What are five main conditions that results from the development of gallstones?
a) Asymptomatic Cholelithiasis
b) Biliary Colic
c) Cholecystitis
d) Choledocholithiasis
e) Cholangitis
What issue?
The condition in which a patient has gallstones present, but has not had any symptoms associated with them.
a) These stones are almost always found incidentally during a work-up for other health issues.
b) 80% of individuals with gallstones will be asymptomatic throughout their entire life.
Asymptomatic cholelithiasis
What issue?
The situation in which gallstones have formed in the patients gallbladder, and they will intermittently obstruct the lumen of the cystic duct.
2) the stones will cause temporary obstruction when the gallbladder contracts, but the stone will eventually dislodge itself.
a) By definition, symptoms will last less than 6 hours
b) There will be no signs or symptoms of an inflammatory process
(1 Normal white blood cell count
(2 No fever
c) These individuals have approximately 1-3% chance of developing
cholecystitis or choledocholithiasis
Biliary colic
What issue?
Is inflammation of the gallbladder
1) Typically (but not always), the situation leading to the inflammation of the gallbladder occurs when a gallstone get perminently lodged in the cystic duct.
a) By definition, symptoms must be present for over 6 hours
b) These patients will have signs and symptoms of an inflammatory process
(1 Increased white blood cell count
(2 Possible fever
Cholecystitis
What issue?
Refers to inflammation of the gallbladder caused by
obstruction of the common bile duct.
a) Similar to cholecystitis, these patients will show signs and symptoms of an inflammatory response:
(1 Possible fever
(2 Increased white blood cell count
b) They will also have lab values consistent with an obstructed common bile duct.
(1 Increased conjugated bilirubin
(a Bilirubin is conjugated in the liver, transported via the biliary tract into the small intestine to eventually be excreted from the body in the stool.
(b If there is a blockage of the common bile duct this will cause
back-up of contents that would otherwise be excreted by the liver
into the biliary system.
c) These patients may have jaundice, but otherwise it is almost impossible to distinguish between cholecystitis and this by physical exam alone.
Choledocholithiasis
What issue?
Is a bacterial infection of the biliary tract.
a) It was believed that the cause of this was due to an ascending infection into the biliary tract from the duodenum, during times of bile stasis (such as what happens in choledocholithiasis).
1) Newer evidence suggests that the infection originates via the portal venous system during times of bile stasis (i.e choledocholithiasis).
2) These patients tend to be very sick.
3) Since this disease process is almost always seen in patients that have choledocholithiasis, these patients will have all the signs and symptoms of choledocholithiasis in combination with:
a) Charcot’s Triad
(1 RUQ Pain
(2 Fever
(3 Jaundice
Cholangitis
What is Charcot’s Triad
(1 RUQ Pain
(2 Fever
(3 Jaundice
