Gall Bladder 01

Question 1

What parts of the GI (layers) does the gallbladder not contain?

Answer 1

muscularis mucosae
submucosa

Question 2

What’s to the most common gallbladder anomaly?

Answer 2

folded fundus “Phrygian Cap”

Question 3

95% of biliary tract disease is attributable to what?

Answer 3

gallstones

Question 4

What are the predisposing conditions that would cause one to have gallstones? (cholesterol stones)

Answer 4

fat
female
fertile
forty
fair
flatulence (has to do with digestion)

Question 5

What are risk for having pigment stones?

Answer 5

chronic hemolytic syndromes

infection

Question 6

Describe pathology behind how cholesterol stones are formed.

Answer 6

• Supersaturation of the bile with cholesterol
• Hypomotility of the gallbladder (stasis)
• Accelerated cholesterol crystal nucleation
• Mucus hypersecretion to trap the crystals

Question 7

List the pathogenesis of pigment stones.

Answer 7

1. Hemolytic anemias
2. Infections of the biliary tract

Question 8

Are most cholesterol stones radiolucent or radiopaque?

Answer 8

radiolecent

Question 9

What are the 2 types of pigment stones?

Answer 9

black stones

brown stones

Question 10

What is the composition of black pigment stones?

Answer 10

oxidized polymers of calcium salts of UC bilirubin(UCB) mostly

Question 11

Are black stones radiolucent or radiopaque?

Answer 11

radiopaque

Question 12

What are brown pigment stones caused by?

Answer 12

infected intrahepatic or extrahepatic ducts

Question 13

Are brown pigment stones radiolucent or radiopaque?

Answer 13

radiolucent some sources say radiopaque

Question 14

What are some clinical features of cholelithiasis?

Answer 14

excruciating pain, either constant or “colicky” (spasmodic), often follows a fatty meal,

localized to the right upper quadrant/epigastrium, may radiate to shoulder/back.

Question 15

Name for inflammation of the gallbladder?

Answer 15

cholecystitis

Question 16

Complications caused by cholelithiasis?

Answer 16

empyema, Perforation, Fistulae, Inflammation of biliary tree, and Obstructive cholestasis or Pancreatitis

Question 17

Gallstone ileus meaning.

Answer 17

large stone erodes directly into an adjacent loop of small bowel causing intestinal obstruction (Bouveret’s syndrome)

Question 18

Describe empyema gall bladder.

Answer 18

Secondary infection of the gallbladder in which it is filled with pus due to a calculus impacting outlet of the gallbladder (cystic duct)

Question 19

What is acute calculous cholecystitis?

Answer 19

inflammation of the gallbladder due to stones

Question 20

Pathogenesis of acute calculus cholescystitis?

Answer 20

The protective mucus layer of the gallbladder is disrupted and the mucosal epithelium exposed to harsh bile salts.

Prostaglandins released creating an inflammatory response.

Distention and increased intraluminal pressure compromise blood flow to the mucosa.

These events initially occur in the absence of bacterial infection, but later in the course bacterial infection may be superimposed and exacerbate the inflammatory process.

Question 21

What are risk factors for acute non-calculous cholecystitis?

Answer 21

1. Sepsis with hypotension and multisystem organ failure
2. Immunosuppression;
3. Major trauma and burns
4. Diabetes mellitus
5. Infections

Question 22

What are major indications of acute cholecystitis?

Answer 22

Steady or Colicky pain (progressive right upper quadrant or epigastric pain that last > 6 hours) + Fever + Leukocytosis,

No jaundice

Question 23

Is a prerequisite of obstruction to gallbladder outflow necessarily needed to have chronic cholecystitis?

Answer 23

no; but it is associated with cholelithiasis in over 90% of cases.

Question 24

What is the best way to diagnose chronic cholecystitis?

Answer 24

Ultrasonography

Question 25

What is porcelain gallbladder?

Answer 25

• Uncommon manifestation of chronic cholecystitis, characterized by extensive dystrophic calcification within the gallbladder wall

Question 26

Is porcelain gallbladder considered metastatic calcification?

Answer 26

yes

Question 27

Describe the appearance of xanthogranulomatous cholecystitis.

Answer 27

• Abundant macrophages filled with lipids are admixed with fibrosis
• Can be confused macroscopically with a malignant neoplasm

Question 28

What is cholesterolosis?

Answer 28

excess cholesterol in bile

forms excess cholesterol deposits in macrophages (seen as yellow, speckled mucosal surface)

Question 29

What is “strawberry gall bladder” and indication of?

Answer 29

excess cholesterol in bile; cholesterol deposits in macrophages producing a yellow, speckled mucosal surface

Question 30

What is hydrops of the gallbladder?

Answer 30

distended gallbladder caused by chronic obstruction of the cystic duct

Question 31

Describe appearance of hydrops of the gallbladder

Answer 31

• Distended GB with atrophy of the mucosa/muscle
• Clear secretions

Question 32

How is hydrops of the gallbladder treated?

Answer 32

surgically

Question 33

Right upper quadrant pain + fever + absolute neutrophilic leukocytosis with left shift.

Answer 33

acute cholecystitis

Question 34

Right upper quadrant pain + jaundice (increased serum AST/ALP + serum bilirubin >4 mg/dL, usually indicates a stone in common bile duct .

Answer 34

choledocholithiasis

Question 35

Right upper quadrant pain + jaundice + fever (Charcot triad)

Answer 35

ascending cholangitis

Question 36

Be able to reproduce this chart.

Answer 36