Diseases of the GB 1 Flashcards
Bile in the gallbladder is bile salts or bile acid form?
bile salts in gallbladder
Explain the synthesis of bile salts.
How does FGF19 suppress synthesis of bile acids?
suppresses synthesis of bile acids from cholesterols by inhibiting cytP450
Cholesterol stones are formed due to excess of cholesterol in relation to what other molecules?
phospholipids and bile acids
In what conditions are pigment stones common?
in hemolytic anemias; such as sickle-cell disease and hereditary spherocytosis
What type of patients that present with cholelithiasis but are asymptomatic may also be recommended for a cholecystectomy?
immunocompromised patients
diabetics
morbidly obese
etc.
What is a biloma?
Collection of bile within the abdominal cavity
When is it likely to have abiloma?
when there is a lie leak for example after laparoscopic cholecystectomy
What is gallstone ileus?
rare but when in cases of severe inflammation the gallstone erodes through the gallbladder into adherent bowel potentially causing obstruction
Cholecystoenteric fistula
can be caused if you don’t remove a gallstone at an early age/ The stone erodes through the gallbladder into the adherent bowel
Can potentially cause obstruction
What are things that can cause calculus cholecystitis?
- salmonellosis
- polyarteritis nodosa
- GB sludge
- blockage from a tumor
- Prolonged fasting
What are some clinical manifestations of acute choelcystitis?
Be able to understand this chart.
Understand flow diagram.
Where is Boas’s sign felt?
pain in the area below the right scapula
Does cholecystitis manifest with jaundice?
no; jaundice only occurs when CBD is obstructed.
Some differential diagnosis with cholecystitis?
intra-abdominal
Peptic ulcer, (perforated)
acute pancreatitis
non-intra-abdominal
myocardial infarction
pneumonia (R. basilar)
Why may BUN be increased in cholecystitis?
due to dehydration
What does HIDA stand for?
hepatobiliary iminodiacetic acid
What is a HIDA scan?
a hepatobiliary scan (nuclear scan) that only shows if the cystic duct is obstructed
What is what test of choice for evaluation of cholecystitis if it is suspected?
Abd. Ultrasound
Abd. US
When diagnosing cholecystitis what are we checking for on plain films?
looking fro air under the diaphragm
What is Rigler’s sign?
evidence of pneumoperitoneum (also known as the double wall sign, is seen on a radiograph of the abdomen when the air is present on both sides of the intestine)
Infections by what organisms can cause emphysematous GB?
Clostridium Welchii/ perfringens, Escherichia coli and Bacteroides fragilis]
Why is gall stone ileus a misnomer?
it is actually a small bowel obstruction
If there is concomitant choledocholithtiasis with cholecystitis what operation procedure is to be done?
a preoperative ERCP with removal of the stone before the cholecystectomy
