Gall Bladder/Biliary Tract Disorders

Question 1

Types of Gallstones

Answer 1

Cholesterol stones 90%
Pigmented (10%)
Black stones (contain Ca bilirubinate, a/w cirrhosis and hemolysis)
Brown stones (a/w biliary tract stasis & infection)

Question 2

Acute cholecystitis H & P

Answer 2

RUQ or epigastric pain may have radiation to right shoulder, often occurs after fatty meal.
anorexia, nausea and vomiting, fever
(+) Murphy’s sign
Palpable enlarged gallbladder: 1/3 patients
Jaundice

Question 3

Porcelain gallbladder

Answer 3

An uncommon condition; however important to recognize the imaging characteristics because of the risk of GB adenocarcinoma in porcelain gallbladder

Question 4

Cholangitis Charcot’s triad (50-70%)

Answer 4

RUQ pain
Jaundice
Fever and chills

Question 5

Primary sclerosing cholangitis

Answer 5

characterized by diffuse inflammation of biliary tract
Etiology unknown
Fibrosis and strictures develop
More common in men, age 20-40
Closely associated with ulcerative colitis
Increased risk for cancer
Most asymptomatic, may have jaundice

Question 6

Primary Biliary Cirrhosis (PBC)

Answer 6

Slowly progressive autoimmune liver disease
90% females
Peak incidence in 40’s
destruction of intrahepatic bile ducts
Leads to cirrhosis and liver failure
90-95% have antimitochondrial antibody (AMA)

Question 7

TUMORS OF THE AMPULLA OF VATER

Answer 7

Present most commonly with obstructive jaundice

Surgery: Whipple procedure

Question 8

CAUSES OF HYPERBILIRUBINEMIA

Answer 8

Increased production: Hemolytic disease
Isoimmune-mediated hemolysis (ABO or Rh(D) incompatibility).
hereditary spherocytosis, elliptocytosis
Erythrocyte enzymatic defects (G6PD) deficiency, pyruvate kinase deficiency, and congenital erythropoietic porphyria).
Sepsis
Polycythemia

Decreased clearance

Question 9

GILBERT’S syndrome Labs

Answer 9

Lab work will show predominantly elevated unconjugated bilirubin (indirect) bilirubin, while conjugated (direct) bilirubin is usually WNL and all other LFT’s will be normal