Diseases of the Gallbladder

Question 1

A patient with painless jaundice weight loss and a palpable RUQ mass has what suspected diagnosis?

Answer 1

Gallbladder or Pancreatic cancer

Question 2

What is the next test of choice in a patient with RUQ pain and an inconclusive US for cholecystitis?

Answer 2

Nuclear scan (HIDA or PIPIDA)

Question 3

A patient presents to your office with weight loss and a palpable mass in the right upper quadrant. What X-ray finding supports gallbladder cancer?

Answer 3

Porcelain gallbladder

Question 4

A patient with cholangitis develops confusion and hypertension. What do you suspect?

Answer 4

Acute obstructive suppurative cholangitis

Question 5

A patient presents with fever, jaundice, and right upper quadrant pain. What do you suspect?

Answer 5

cholangitis

Question 6

During exam, palpation of the right upper quadrant during inspiration causes the patient to stop breathing in due to pain? What is the initial test of choice?

Answer 6

RUQ ultrasound

Question 7

What antibiotic is a major cause of biliary sludge?

Answer 7

Ceftriaxone

Question 8

Charcot’s triad (describing the presentation of cholangitis)

Answer 8

RUQ tenderness, jaundice, fever

Question 9

Reynold’s pentad

Answer 9

Charcot’s triad + altered mental status and hypotension

Question 10

Jaundice and pruritus. Associated with IBD, cholangiocarcinoma, pancreatic cancer, colorectal cancer

Answer 10

Primary sclerosing cholangitis

Question 11

Accounts for > 85% of gallstones in the Western world

Answer 11

cholesterol stones

Question 12

Slate colored skin may represent which underlying GI disorder?

Answer 12

primary biliary cirrhosis

Question 13

Diffuse, multifocal strictures and focal dilation of bile ducts with a “beaded look” are found on a patient with ulcerative colitis. What is your suspected diagnosis?

Answer 13

Primary sclerosing cholangitis

Question 14

What are +Anti-Mitochondrial antibodies associated with?

Answer 14

primary biliary cirrhosis

Question 15

What is the Dx? Fatigue Pruritus hepatomegaly associated with high alk phos cholesterol and bilirubin.

Answer 15

primary biliary cirrhosis

Question 16

What disease process does Charcot’s triad (fever, jaundice and RUQ pain) suggest?

Answer 16

cholangitis

Question 17

What does a porcelain gallbladder or a radiopaque gallbladder on imaging suggest?

Answer 17

gall bladder cancer

Question 18

RUQ palpation maneuver reveals pain and cessation of inspiration. What is this called? What does it indicate?

Answer 18

Murphy’s sign = cholecystitis

Question 19

Primary biliary cirrhosis often has high elevation of alkaline phosphatase and bilirubin levels. What is the gold standard for diagnosis?

Answer 19

Gold standard - antimitochondrial antibodies found with liver biopsy