Fiser ABSITE Ch. 32 Gallbladder

Question 1

the gallbladder lies between these 2 liver segments

Answer 1

segment 4 and 5

Question 2

cystic artery is a branch off of this

Answer 2

right hepatic artery

Question 3

name the boundaries of callot triangle

Answer 3

cystic duct laterally, common bile duct medially, liver superior

Question 4

these arteries were considered longitudinal blood supply to the hepatic and common bile duct, lies in a 3 and 9:00 position

Answer 4

right hepatic, retroduodenal, (branches of gastroduodenal artery)

Question 5

where the cystic veins drain

Answer 5

right branch of the portal vein and into the liver

Question 6

where the biliary lymphatics located with respect to the common bile duct

Answer 6

right side

Question 7

name the parasympathetic and sympathetic innervation to gallbladder

Answer 7

parasympathetic: Left (anterior) the trunk of the vagus, sympathetic from T7-T10

Question 8

which epithelial layer as the gallbladder lack compared to the rest of the GI tract

Answer 8

no submucosa

Question 9

this hormone relaxes the sphincter of oddi

Answer 9

glucagon

Question 10

give the normal size for: common bile duct, gallbladder wall, pancreatic duct

Answer 10

common bile duct -less than 8 mm; Gallbladder wall - less than 4 mm; pancreatic duct - less than 4 mm

Question 11

where is the highest concentration of CCK and secretin cells

Answer 11

duodenum

Question 12

these are invagination of the epithelium of the wall of the gallbladder, formed by increased gallbladder pressure

Answer 12

Rokitansky-Aschoff sinuses

Question 13

name 3 things that increase bile excretion

Answer 13

CCK, Secretin, Vagal input

Question 14

name 3 things that decrease bile excretion

Answer 14

VIP, Somatostatin, Sympathetics

Question 15

name 3 essential functions of bile

Answer 15

fat-soluble vitamin absorption, bilirubin excretion, cholesterol excretion

Question 16

where does bile become concentrated and how

Answer 16

in the gallbladder, resorption of sodium and water

Question 17

where does the active resorption of conjugated bile acids occur

Answer 17

terminal ileum

Question 18

name the 2 cells which secrete bile

Answer 18

bilateral canalicular cells, 20%; hepatic sites, 80%

Question 19

we gives bile its green color

Answer 19

conjugated bilirubin

Question 20

this is a breakdown product of conjugated bilirubin in the gut, it gives stool a brown color

Answer 20

stercobilin

Question 21

breakdown product of conjugated bilirubin, gives urine its yellow color

Answer 21

urobilin

Question 22

this is the rate limiting step in cholesterol synthesis

Answer 22

HMG coA reductase

Question 23

name the 2 enzymes in bile acids synthesis

Answer 23

HMG coA reductase, 7-alpha- hydroxylase

Question 24

give cause of cholesterol stone formation in thin versus overweight people

Answer 24

thin, underactive 7-alpha- hydroxylase; overweight, overactive HMG coA reductase

Question 25

name 4 factors that increased cholesterol insoluabilization

Answer 25

1) stasis 2) calcium nucleation 3) increased water absorption in the gallbladder 4) decreased lecithin and bile acids

Question 26

which gallstone is more common in United States

Answer 26

nonpigmented, cholesterol

Question 27

black pigmented gallstones: 4 common causes

Answer 27

1) hemolytic disorders 2) cirrhosis 3) chronic TPN 4) status post ileal resection

Question 28

black pigmented gallstones: 3 key factors for development

Answer 28

increased bilirubin load, decreased hepatic function, bile stasis

Question 29

black pigmented gallstones: where do they form, treatment

Answer 29

within the gallbladder, cholecystectomy

Question 30

brown pigmented gallstones: pathophysiology of formation

Answer 30

infection causing deconjugation of bilirubin

Question 31

brown pigmented gallstones: most common cause, commonly seen in this population

Answer 31

E. coli, Asian

Question 32

brown pigmented gallstones: where do they form

Answer 32

common bile duct

Question 33

these 2 gallstones are considered secondary common bile duct stones. (formed in the gallbladder)

Answer 33

cholesterol stones, black stones

Question 34

3 most common bacteria in cholecystitis

Answer 34

1) E. coli 2) Klebsiella 3) Enterococcus

Question 35

name 4 preemptive conditions which increased risk for acalculus cholecystitis

Answer 35

1) Severe burns 2) Prolonged TPN 3) Trauma 4) Major surgery

Question 36

emphysematous gallbladder disease: Describe, Seen in this population, Most common etiology

Answer 36

gas within the gallbladder wall; diabetics; Clostridium perfringens

Question 37

emphysematous gallbladder disease: Signs and symptoms, Treatment

Answer 37

severe, rapid onset abdominal pain, nausea, vomiting and sepsis; Emergency cholecystectomy or percutaneous drainage if unstable

Question 38

pathophysiology of gallstone ileus

Answer 38

fistula between the gallbladder and duodenum, releases stone causing small bowel obstruction... seen in the elderly

Question 39

gallstone ileus: Common finding on plain film, Most common site of obstruction

Answer 39

pneumobilia; terminal ileum

Question 40

gallstone ileus: Treatment

Answer 40

enterotomy and possible resection to remove stone, cholecystectomy with fistula resection

Question 41

pelvis common bile duct injury treatment differentiated

Answer 41

if greater than 2 mm will need hepaticojejunostomy

Question 42

this is the most important cause of the leak postoperative biliary stricture

Answer 42

ischemia

Question 43

name 2 treatments for common bile duct or hepatic duct strictures

Answer 43

ERCP with sphincterotomy and stent placement; PTC tube

Question 44

most common cancer of the biliary tract: First site of metastasis, Typical symptoms

Answer 44

gallbladder adenocarcinoma; Segments 4 and 5 of the liver; Jaundice first then right upper quadrant pain

Question 45

differentiate stage I versus stage II gallbladder: adenocarcinoma, treatment for each

Answer 45

1-limited to the gallbladder mucosa; cholecystectomy; 2-into the muscle; wide resection around liver bed with possible Whipple

Question 46

choledochal cyst: common etiology, signs and symptoms

Answer 46

female, Asian, 90% extrahepatic, 15% cancer risk; episodic pain, fever, jaundice, cholangitis

Question 47

choledochal cyst: most common type, describe

Answer 47

1, fusiform or saccular dilation of extrahepatic ducts

Question 48

give treatment for type one choledochal cyst

Answer 48

cyst excision with hepaticojejunostomy and cholecystectomy

Question 49

described type 4 and type V choledochal cysts

Answer 49

4-partially intrahepatic, 5-caroli's disease, total he intrahepatic requiring partial liver resection

Question 50

30-40-year-old male patient presents with fatigue, fluctuating jaundice, pruritis, weight loss, right upper quadrant pain

Answer 50

primary sclerosing cholangitis

Question 51

in 2 complications of primary sclerosing cholangitis

Answer 51

cirrhosis; cholangiocarcinoma

Question 52

2 medications which can be used in primary sclerosing cholangitis, give affect of each

Answer 52

cholestyramine -- decrease pruritis symptoms by decreasing bile acids; UDCA -- decrease symptoms and improve liver function

Question 53

primary biliary cirrhosis: Most common in, Symptoms, Key lab value

Answer 53

women; Fatigue, itching, jaundice, xanthomas; Positive antimitochondrial antibodies

Question 54

Charcot's triad

Answer 54

right upper quadrant pain, Fever, Jaundice

Question 55

reynolds Pentad

Answer 55

1) Right upper quadrant pain 2) Fever 3) Jaundice 4) Altered mental status 5) Shock

Question 56

2 most common pathogens associated with cholangitis

Answer 56

Escherichia coli, Klebsiella

Question 57

give differential diagnoses for shock following laparoscopic cholecystectomy: Early-first 24 hours, Late-after 24 hours

Answer 57

early hemorrhagic shock from clip falling off the cystic artery; Late-septic shock from accidental clip the common bile duct with subsequent cholangitis

Question 58

thickened nodule the mucosa and muscle associated with Rokitansky Ashcroft sinuses, Not premalignant; Give treatment

Answer 58

adenomyomatosis; Cholecystectomy

Question 59

benign neuroectoderm tumor of gallbladder, Can occur in biliary tract with signs of cholecystitis; Give treatment

Answer 59

granular cell myoblastoma; Cholecystectomy

Question 60

speckled cholesterol deposits on the gallbladder wall

Answer 60

cholesterolosis

Question 61

2 signs concerning for malignancy and gallbladder polyps

Answer 61

greater than 1 cm; Patient greater than 60 years old

Question 62

type of bilirubin down to albumin covalently, half-life of 18 days

Answer 62

delta bilirubin

Question 63

compression of the common hepatic duct by a stone in the infundibulum of the gallbladder or inflammation arising from the gallbladder or cystic duct extending to the contiguous hepatic duct causing stricture and hepatic duct obstruction

Answer 63

mirizzi syndrome

Question 64

this antibiotic can cause gallbladder sludge and cholestatic jaundice

Answer 64

ceftriaxone