Diseases of the Gallbladder

Question 1

Name diseases of the gall bladder?

Answer 1

1. gallstones (cholelithiasis) - most common 2. Then cholecystitis (acute or chronic) 3. Congenital anomalies like agenesis 4. Carcinoma of the gallbladder

Question 2

List the two main types of gallstones and briefly explain their demographics?

Answer 2

1. cholesterol stones 2. pigment stones

Question 3

Describe cholesterol stones?

Answer 3

1. Contain 80% crystalline cholesterol monohydrate 2. yellow in colour

Question 4

Epidemiology?

Answer 4

common in the Europe, America - industrialised countries

Question 5

Describe pigment stones?

Answer 5

1. Common in low social-economic populations 2. Composed of bilirubin calcium salts

Question 6

List the risk factors for the development of cholesterol stones?

Answer 6

1. : industrialised countries: America and Europe 2. advancing age 3. Female sex hormones 4. obesity 5. rapid weight reduction 6. gallbladder stasis 7. Inborn error of bile acid metabolism 8. Hyperlipidaemia syndromes

Question 7

List the risk factors for the development of pigment stones?

Answer 7

1. demography - Low socio-economic status + rural and urban poor 2. Chronic haemolytic syndromes 3. Biliary infection

Question 8

Discuss the pathogenesis of cholesterol stones?

Answer 8

1. Excess cholesterol in bile (hypersaturation) as a result of liver hypersecretion of cholesterol Gallbladder hypomotility: toxic effects of cholesterol on mucosa 2. Cholesterol nucleation in gallbladder 3. Mucous in gallbladder traps the crystals growing into macroscopic stones 4. ?

Question 9

Discuss the pathogenesis of pigment stones?

Answer 9

1. Mixture of unconjugated bilirubin with inorganic calcium salts 2. Unconjugated bilirubin increases with infection of the biliary tract (E.coli, Ascaris etc) 3. Haemolytic anaemias increases bilirubin concentration

Question 10

Describe the morphology of cholesterol stones?

Answer 10

1. round to ovoid, multifaceted 2. Fine granular, hard surface, glistening 3. Radio-lucent

Question 11

Describe the morphology of pigment stones?

Answer 11

1. black or brown in colour 2. usually soft 3. radio-opaque

Question 12

What are the clinical features of gallstones?

Answer 12

1. Majority are asymptomatic 2. Right upper abdominal colicky pain (spasmodic) 3. Concomitant cholecystitis

Question 13

What are the investigations that can be taken?

Answer 13

1. Ultrasound scan 2. Xrays

Question 14

List the complications of gallstones?

Answer 14

1. Gallbladder empyema
2. Perforation
3. Cholangitis: inflammation of biliary tree
4. Obstructive cholestasis with jaundice 5. Acute pancreatitis
5. Increased risk of gallbladder carcinoma

Question 15

What is cholecystits?

Answer 15

inflammation of the gallbladder - can acute or chronic

Question 16

Describe acute cholecystitis?

Answer 16

1. Usually in association with gallstones (calculous cholecystitis) 2. Can be alcalculous: in setting of severe systemic derangements

Question 17

Acute cholecystitis is Associated with?

Answer 17

1. Post-operative state after non biliary surgery 2. Severe trauma, severe burns 3. Multisystem organ failure 4. sepsis

Question 18

Describe calculous cholecystitis?

Answer 18

1. Chemical and physical irritation of the bladder with 2. subsequent inflammation

Question 19

Describe acalaculous cholecystitis?

Answer 19

results from derangements that cause ischaemia to the gallbladder

Question 20

What are the clinical features?

Answer 20

1. Can present with sudden onset as an acute surgical emergency or as mild pain 2. Right upper quadrant pain 3. Epigastric pain 4. Mild fever, tachycardia 5. Sweating, nausea and vomiting 6. Tender abdomen

Question 21

Describe chronic cholecystitis?

Answer 21

1. Occur as a result of repeated bouts of mild to severe acute cholecystitis 2. Associated with cholelithiasis in majority 3. Symptoms similar to acute cholecystitis but indolent/protracted 4. Gallbladder wall is thickened and shows chronic inflammation

Question 22

Complications of acute and chronic cholecystitis?

Answer 22

1. Bacterial superinfection with sepsis 2. Gallbladder perforation 3. abscess formation 4. Gallbladder rupture with peritonitis 5. Biliary-enteric fistulas