Gall Bladder

Question 1

• Name for gall stones? types? (2) % asymptomatic? Due to? (2)
• Stones risk for acute cholecystitis? Acute panc?
• At risk for chol. stones? (7)
• Risk for pigment stones? (4)
• Lig of treitz? where do stones lodge?
• Cholecystitis: Acute due to? Chronic? Infl + ?
• Carcinoma: Rare but? Type? Risk factors?

Answer 1

• Choleltihs; pigment, choleterol; 90; high chol output or low bile synthesis
• 90%; 40%
• 5 F’s; NA/Cauc; rapid weight loss
• Asian; hemo syndromes; Ileal disease; Bil. Infection
• End of duodemun; after the ligament
• Gall stones; gall stones; fibrosis
• Lethal; Adenocarcinoma; chronic infection/gall stones

Question 2

• Bile Duct: Stone in bil. tree? Congenital? Major risk for?
• Bile duct carcinoma: Type? Risk factors? (3)
• Acute Panc: Causes? (2) Obstruction leads to? (2) Alcohol causes what? (3)
• Chronic panc: Irreversible? Due to? (3)
• Sequelae of both? (4)
• Ductal adenocarcinoma: % of panc. cancers? 4th what?
• Endocrine Neoplasm: types? (2) most clinically relevant?

Answer 2

• Cholodocholithiasis; can be (choledochal cysts); ascending chelengitis
• Rare; Adenocarcinoma; choledochal cyst, PSC, flukes
• 45% stones, 35% Alcohol, Incr. intraductal pressure and leakage of enzyme rich fluid; defective enzyme packaging, secretion stim., sphincter of oddi contraction
• No; alcohol, obstruction, hereditary
• Pseudocysts, abscess, Panc. Insuff., DM
• Functional (insulinemia > gastronemia> glucagon); non-functional; non-functional

Question 3

• Functions of gall bladder: Fasting? Fed?
• What is bile? (4) Brown stone?
• 3 parts of patho?
  1. ) Biliary colic: Pain when? Treatment?
  2. ) Calcuous Cholecystitis: Stone where? Transmural? Treatment? (4)
  3. ) Acalculous: Cause? (2) Treatment?
  4. ) Choledocho: Signs? (2); Dx with? (3)

Answer 3

• Store/conc. bile; contracts to deliver bile
• water, bile salts, bili, cholesterol; bacteria
• Stasis + saturation (lithogenic) + mucin plug (nucleation)
  1. ) Fatty meal; lapro. cholecystectomy
  2. ) Cystic duct; inflamm.; NPO, AB’s, pain, cholecsyt.
  3. ) Ischemia/vasculitis; drain/cholecyst.
  4. ) Jaundice/dark urine; liver chem, US, ERCP

Question 4

5. ) Ascending Chol.: With? Charcots triad? Reynolds? Treatment? (3)
6. ) Biliary Stricture: Present with? ALT/AST?
7. ) PSC: Assoc with? Also occurs with? Increased risk of? AST/ALT? Treatment?
8. ) Sphincter of Oddi Dysfx: Increased liver enzymes? DX with?
   - Ultrasound: Accuracy for stones? Cholecytitis? CDL?

Answer 4

5. ) Due to CDL; Fever RUQ pain, Jaundice; hypo and altered MSE; NPO, IV AB, ERCP
6. ) Jaundice, dark urine, pruritis;»_space;»ALT/AST
7. ) UC; Liver cirrhosis; Cholangiocarcinoma; >AST/ALT, liver transplant
8. ) Yes; ERCP
   - 95%, 80%, 50%