Diseases of the Gallbladder and Biliary System Flashcards
Name the radiologic procedure of choice for diagnosing cholelithiasis.
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.
Define “acalculous cholecystitis”
~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
Choledocholithiasis
Presence of stones within the biliary tree
Cholangitis
Acute inflammation of the walls of the bile ducts
Cholecystitis
Inflammation of the gallbladder
Cholelithiasis
Gall stones in the gallbladder lumen
What are the most common kind of gallstones?
Cholesterol Stones
What are the risk factors for cholesterol gall stones?
Female Fat Forty Fertile Flatulant
What is is the most comon manifestation of symptomatic gallstones?
Biliary Colic - pain lasts less than 3 hours
Where does biliary colic pain radiate?
To the right shoulder or scapula
Acute Cholecystitis
Symptoms characterized by acute onset of right upper quadrant pain, fever and leukocytosis.
As in biliary colic, pain may radiate to right shoulder.
Murphy Sign
It is an arrest in inspiration during direct palpation of the right upper quadrant
Acute cholecystitis develops because a gallstone (or gallstones) usually obstructs what?
Cystic Duct
What characterizes the type of gallstone that is more likely to cause acute cholecystsis?
Small gravel like stone
What are potential complications of acute cholecystitis?
Bacterial superinfection
Sepsis
Perforation of gallbladder
Cholecystoenteric fistula (fistula formatoin between gallbladder and the intestine
HIDA Scan
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.
Porcelain Gallbladder
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)
What is the most common clinical presentation of extra-hepatic cholangiocarcinomas?
Jaundice
One of the most common micro-organisms cultured from bile in the setting of acute cholangitis
E. coli
Gallstones may serve as a persistent nidus of infection and risk for chronic carriage of this organism.
Salmonella typhi
Risk factor for cholangiocarcinoma, particularly in Asia (Thailand)
Clonorchis sinensis
