Diseases of the Gallbladder and Biliary System

Question 1

Name the radiologic procedure of choice for diagnosing cholelithiasis.

Answer 1

ULTRASONOGRAPHY has a high sensitivity and specificity for gallstones and should be performed as the diagnostic study of choice when evaluating biliary colic or or cholecystitis.

Question 2

Define “acalculous cholecystitis”

Answer 2

~10% of Gallbladders with all of the pathologic findings of acute cholecystitis contain no gallstones. This is referred to as ACALCULOUS Cholecystitis - associated mortality is high

Question 3

Choledocholithiasis

Answer 3

Presence of stones within the biliary tree

Question 4

Cholangitis

Answer 4

Acute inflammation of the walls of the bile ducts

Question 5

Cholecystitis

Answer 5

Inflammation of the gallbladder

Question 6

Cholelithiasis

Answer 6

Gall stones in the gallbladder lumen

Question 7

What are the most common kind of gallstones?

Answer 7

Cholesterol Stones

Question 8

What are the risk factors for cholesterol gall stones?

Answer 8

Female
Fat
Forty
Fertile
Flatulant

Question 9

What is is the most comon manifestation of symptomatic gallstones?

Answer 9

Biliary Colic - pain lasts less than 3 hours

Question 10

Where does biliary colic pain radiate?

Answer 10

To the right shoulder or scapula

Question 11

Acute Cholecystitis

Answer 11

Symptoms characterized by acute onset of right upper quadrant pain, fever and leukocytosis.

As in biliary colic, pain may radiate to right shoulder.

Question 12

Murphy Sign

Answer 12

It is an arrest in inspiration during direct palpation of the right upper quadrant

Question 13

Acute cholecystitis develops because a gallstone (or gallstones) usually obstructs what?

Answer 13

Cystic Duct

Question 14

What characterizes the type of gallstone that is more likely to cause acute cholecystsis?

Answer 14

Small gravel like stone

Question 15

What are potential complications of acute cholecystitis?

Answer 15

Bacterial superinfection

Sepsis

Perforation of gallbladder

Cholecystoenteric fistula (fistula formatoin between gallbladder and the intestine

Question 16

HIDA Scan

Answer 16

HIDA scan uses technetium labeled hepatic iminodiacetic acid (HIDA) tracer which is injeced intravenously and is then taken up by hepatocytes and excreted in bile. If the cystic duct is patent, the tracer will enter the gallbladder leading to its visualization.

Question 17

Porcelain Gallbladder

Answer 17

Long standing chronic inflammation (ie chronic cholecystitis) may lead to extensive CALCIFICATION of the gallbladder wall.

Porcelain gallbladders are particularly prone to developing gallbladder cancer (adenocarcinoma)

Question 18

What is the most common clinical presentation of extra-hepatic cholangiocarcinomas?

Answer 18

Jaundice

Question 19

One of the most common micro-organisms cultured from bile in the setting of acute cholangitis

Answer 19

E. coli

Question 20

Gallstones may serve as a persistent nidus of infection and risk for chronic carriage of this organism.

Answer 20

Salmonella typhi

Question 21

Risk factor for cholangiocarcinoma, particularly in Asia (Thailand)

Answer 21

Clonorchis sinensis