Gall Bladder 2

Question 1

What is Caroli disease?

Answer 1

A congenital disorder characterized by multifocal, segmental dilatation of large intrahepatic bile ducts

Question 2

What is Caroli syndrome?

Answer 2

cystic biliary dilation and congenital hepatic fibrosis

Question 3

What are some other associated conditions Caroli disease may increase the risk in?

Answer 3

increased risk for cholangiocarcinoma, cholangitis, intrahepatic stones/abscesses

Question 4

How would you treat a person with Caroli disease?

Answer 4

1. resection of the involved lobe
2. liver transplantation

Question 5

What is cholangitis?

Answer 5

acute inflammation of the wall of the bile ducts, mostly a result of bacterial infection

Question 6

What is the most common cause of cholangitis?

Answer 6

• Choledocholithiasis (most common)

Question 7

Pathogenesis of ascending cholangitis.

Answer 7

Propensity of bacteria, once within the biliary tree, to infect intrahepatic biliary ducts (more likely enter the biliary tract through the sphincter of Oddi, rather than by the hematogenous route)

Question 8

What is a common pathogen to enter the biliary system in ascending cholangitis that you need to remember?

Answer 8

clonorchis sinensis

Question 9

What are the clinical features of Charcots Triad in ascending cholangitis?

Answer 9

Fever with chills + abdominal pain + jaundice (Charcot triad)

Question 10

What does ERCP stand for?

Answer 10

Endoscopic retrograde cholangiopancreatography (ERCP)

Question 11

Main features of acute cholecystitis?

Answer 11

Right upper quadrant pain + fever + absolute neutrophilic leukocytosis

No jaundice

Question 12

Main features of choledocholithiasis?

Answer 12

Right upper quadrant pain + jaundice

no fever

Question 13

Main features of Ascending cholangitis.

Answer 13

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

Reynold’s Pentad: Charcot’s Triad + confusion and hypotension

Question 14

What are some of the main causes of secondary biliary cirrhosis?

Answer 14

1. Extrahepatic Cholelithiasis (most common)
2. Biliary atresia
3. Malignancies of biliary tree and head of the pancreas
4. Strictures from previous surgical procedures

Question 15

Be able to reproduce chart differentiating primary biliary cirrhosis, secondary biliary cirrhosis, and primary sclerosing cholangitis.

Answer 15

Question 16

What is biliary atresia?

Answer 16

congenital condition where there is a blockage of tubes (ducts) that carry bile from liver to gallbladder

Question 17

What is the most common malignancy of the extra hepatic biliary tract.

Answer 17

carcinoma of gallbladder

Question 18

Is carcinoma of the gallbladder often discovered in resectable stage?

Answer 18

no rarely discovered at resectable stage and therefore poor prognosis

Question 19

What is the most important risk factor for gallbladder cancer?

Answer 19

gallstones

Question 20

Name another major risk factor for gallbladder cancer that’s not gallstones?

Answer 20

abnormal choledocho-pancreatic duct junction is a risk factor

Question 21

Where are adenocarcinomas of the gallbladder most often detected?

Answer 21

in the fundus

Question 22

Risk factors for cholangiocarcinomas?

Answer 22

Primary Sclerosing Cholangitis, congenital fibropolycystic diseases of the biliary system, HCV infection, hepatolithiasis, chronic infection with liver flukes (Opisthorchis and Clonorchis)

Question 23

Cholangiocarcinomas or tumors arising from the extra hepatic bile ducts as opposed to cholangiocarcinomas from intrahepatic bile ducts are also named what?

Answer 23

biliary adenocarciomas

Question 24

What is a Klatskin tumor?

Answer 24

tumor found at the junction of the right and left hepatic ducts forming common hepatic duct

Question 25

Prognosis for cholangiocarcinomas?

Answer 25

Poor; most patients have unresectable tumors

Question 26

Another name for Courvoisier’s Law?

Answer 26

Palpable gallbladder

Question 27

What is Courvoisier-Terrier sign?

Answer 27

common bile duct obstruction secondary to stone rarely results in bladder dilatation

while in contrast a malignant obstruction of the duct commonly causes bladder dilatation

Question 28

What are the major clinical features of malignancy of the biliary tract or pancreas?

Answer 28

Non-tender palpable gall bladder + Jaundice

Question 29

Painless enlarged gall bladder with jaundice could indicated what condition?

Answer 29

malignancy most likely pancreatic adenocarcinoma

Question 30

What is another name for Primary biliary cirrhosis?

Answer 30

Primary biliary cholangitis