Disease of the Gallbladder

Question 1

what is cholesterosis

Answer 1

an uncommon chronic inflammation of the gall bladder in which small crystals of cholesterol deposit on its internal wall (like a strawberry)

Question 2

constituents of gall stones

Answer 2

calcium combined with
cholesterol 80-95%
OR
bilirubin 5-20%

Question 3

bilirubin in gallstones is un/conjugated

Answer 3

unconjugated - come from the 15 of bile bilirubin which in unconjugated

Question 4

which is more common, cholesterol stones or bilirubin stones

Answer 4

cholesterol stones

Question 5

risk factors of gallstones

Answer 5

FH, increasing age, loss of bile salts, oral contraceptive

Question 6

why would an ileal resection cause gallstones

Answer 6

ileum removed –> reduced reabsorption of bile salts –> fewer bile salts to emulsify cholesterol –> free cholesterol forms stones

Question 7

presentation of gallstones

Answer 7

usually asymptomatic - lots found on autopsy

Question 8

symptomatic presentation of gallstones

Answer 8

biliary colic (right epigastric pain)
jaundice
fat malabsorption

Question 9

what is charcot’s triad

Answer 9

jaundice, fever and right epigastric pain - results from ascending cholangitis

Question 10

what condition of galls stones in common bile duct

Answer 10

choledocho-lithiasis

Question 11

complications of gallstones

Answer 11

ascending cholangitis
choledocho-lithiasis
acute pancreatitis
obstructive jaundice

Question 12

symptoms of obstructive jaundice

Answer 12

pain, jaundice, dark urine, pale stool, pruritis

Question 13

effect of excess circulating bilirubin on skin

Answer 13

pruritis

Question 14

bloods in gallstones

Answer 14

LFTs (AST, ALT, ALP)
Amylase and lipase for pancreas
WCC for infection

Question 15

imaging in gallstones

Answer 15

ultrasound
endoscopic ultrasound
CT scan
IV cholangiography
MRCP
ERCP
PTC

Question 16

medical treatment of gallstones

Answer 16

dissolution by acids

lithotripsy (ultrasound shock waves to break them up)

Question 17

what 2 organs are you worried about in gallstones in the common duct (choledocho-lithiasis)

Answer 17

liver and pancreas

Question 18

surgical treatment of gallstones

Answer 18

laparoscopic cholecystectomy

Question 19

surgical treatment for common bile duct stones

Answer 19

laparoscopic exloration
ERCP removal
transhepatic stone retrieval

Question 20

congenital biliary tract disease

Answer 20

biliary atresia and choledochal cysts

Question 21

what is biliary atresia

Answer 21

obstructed bile flow due to destruction or absence of extra-hepatic ducts

Question 22

when does biliary atresia present

Answer 22

in babies after a few weeks with jaundice

Question 23

characteristics of biliary colic

Answer 23

right upper quadrant, often after a meal, lasting several hours with constant severity

Question 24

what are choledochal cysts

Answer 24

dilatations of extrahepatic ducts

Question 25

what is cholangiocarcinoma

Answer 25

a tumour of the bile duct, usually adenocarcinoma

Question 26

where in the bile duct do cholangiocarcinomas tend to occur

Answer 26

mostly at the hepatic bifurcation but can also be intrahepatic or closer towards ampulla

Question 27

nature of cholangiocarcinoma presentation

Answer 27

obstructive jaundice symptoms

esp itching

Question 28

treament of cholangiocarcinoma

Answer 28

surgical removal

otherwise palliative

Question 29

prognosis of cholangiocarcinoma

Answer 29

very poor