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GI > Gallbladder > Flashcards

Gallbladder Flashcards

1
Q

Gallstone are caused by _

A

Gallstone are caused by precipitation of bilirubin and/or cholesterol in the bile

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2
Q

Gallstones can be diagnosed via (2) modalities _ or _

A

Gallstones can be diagnosed via (2) modalities ultrasound or hepatobiliary iminodiacetic acid (HIDA) scan

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3
Q

The (4) risk factors for cholelithiasis

A

Cholelithiasis risk factors: 4 F’s
1. Fat
2. Female
3. Fertile (pregnant)
4. Forty

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4
Q

The most common type of gallstone is _

A

The most common type of gallstone is cholesterol gallstone

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5
Q

_ is an enzyme that converts cholesterol –> bile

A

Cholesterol 7a-hydroxylase is an enzyme that converts cholesterol –> bile
* This is a rate limiting step of bile production

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6
Q

Cholesterol gallstone formation is associated with (high/low) cholesterol and (high/low) bile

A

Cholesterol gallstone formation is associated with high cholesterol and low bile
* Recall that cholesterol –> bile via 7a-hydroxylase

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7
Q

Explain the pathogenesis of cholesterol gallstones

A

Supersaturation of cholesterol + insufficient bile acids/salt + biliary stasis –> stone

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8
Q

Cholesterol gallstones are associated with the following risk factors:

A

Cholesterol gallstones are associated with the following risk factors:
* Native Americans
* Rapid weight loss
* Fibrates
* Age
* Obesity
* Crohn’s disease

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9
Q

Cholesterol gallstones are (radiolucent/radiopaque)

A

Cholesterol gallstones are radiolucent

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10
Q

Black pigmented gallstones result from _

A

Black pigmented gallstones result from hemolysis

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11
Q

Explain the pathogenesis of black pigmented gallstones

A

Hemolysis –> increase in unconjugated bilirubin –> increase in calcium bilirubinate

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12
Q

Brown pigmented gallstones result from _

A

Brown pigmented gallstones result from infection

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13
Q

Explain the pathogenesis of brown pigmented gallstones

A

Infection –> increase in beta-glucuronidase –> increase in calcium bilirubinate, increase in fatty acids

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14
Q

Brown pigmented gallstones most commonly result from infection with _ or _

A

Brown pigmented gallstones most commonly result from infection with E.coli or Clonorchis sinensis

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15
Q

Associated risk factors of pigmented gallstones include:

A

Associated risk factors of pigmented gallstones include:
* TPN
* Alcoholic cirrhosis
* Crohn’s disease
* Hemolysis
* Biliary infection

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16
Q

Cholecystitis is _

A

Cholecystitis is acute or chronic inflammation of the gallbladder due to cystic duct obstruction

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17
Q

Cholecystitis is caused by an obstruction in _

A

Cholecystitis is caused by an obstruction in cystic duct

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18
Q

Cholecystitis may be suspected with a positive _ (physical exam finding)

A

Cholecystitis may be suspected with a positive Murphy’s sign

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19
Q

_ sign is arrest of inspiration during palpation of the RUQ

A

Murphy’s sign is arrest of inspiration during palpation of the RUQ

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20
Q

A positive Murphy’s sign is arrest of inspiration during palpation of _ quadrant

A

A positive Murphy’s sign is arrest of inspiration during palpation of RUQ

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21
Q

_ is a form of cholecystitis caused by stasis, hypoperfusion, or infection (hypokinesis of gallbladder emptying) that mainly occurs in critically ill patients

A

Acalculous cholecystitis is a form of cholecystitis caused by stasis, hypoperfusion, or infection (hypokinesis of gallbladder emptying) that mainly occurs in critically ill patients

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22
Q

_ is a gallstone in the common bile duct

A

Choledocholethiasis is a gallstone in the common bile duct

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23
Q

Expected lab findings in a choledocholethiasis

A

Expected lab findings in a choledocholethiasis:
* Elevated ALP
* Elevated GGT
* Elevated conjugated bilirubin
* Elevated AST/ALT

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24
Q

Ascending cholangitis is _

A

Ascending cholangitis is infection of the biliary tree due to stasis/obstruction

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25
Q

Ascending cholangitis may present with _ phenomenon

A

Ascending cholangitis may present with Charcot’s triad
* Jaundice, fever, RUQ pain

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26
Q

Charcot’s triad presents with _ pathology

A

Charcot’s triad presents with ascending cholangitis

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27
Q

Charcot’s triad encompasses:

A

Charcot’s triad encompasses:
1. Jaundice
2. Fever
3. RUQ pain

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28
Q

Reynold’s pentad includes Charcot’s triad + _ and _

A

Reynold’s pentad includes Charcot’s triad + altered mental state and shock

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29
Q

A gallstone at the ampulla of vater can lead to _

A

A gallstone at the ampulla of vater can lead to acute pancreatitis

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30
Q

A fistula between the gallbladder and bowel can lead to _

A

A fistula between the gallbladder and bowel can lead to gallstone ileus
* The gallstone enters the intestinal lumen –> ileocecal valve

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31
Q

Signs of a gallstone ileus:

A

Signs of a gallstone ileus: Rigler triad
1. Pneumobilia (air in biliary tree)
2. Small bowel obstruction
3. Gallstone visualized

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32
Q

Inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts is called _

A

Inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts is called primary sclerosing cholangitis

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33
Q

PSC will show periductal fibrosis with _ appearance

A

PSC will show periductal fibrosis with onion-skin appearance

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34
Q

PSC will appear with _ sign on contrast imaging

A

PSC will appear with beading on contrast imaging
* Uninvolved regions are dilated
* Alternating strictures and dilations

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35
Q

PSC most commonly presents with _

A

PSC most commonly presents with obstructive jaundice
* Pruritis, pale stool, dark urine

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36
Q

A late complication of PSC is _

A

A late complication of PSC is cirrhosis

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37
Q

Etiology of PSC is largely unknown but it is commonly associated with _ and may have a positive _

A

Etiology of PSC is largely unknown but it is commonly associated with ulcerative colitis and may have a positive p-ANCA

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38
Q

PSC is associated with HLA markers _ and _

A

PSC is associated with HLA markers HLA-B8 and HLA-DR3

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39
Q

PSC is associated with an increased risk of _ malignancy

A

PSC is associated with an increased risk of cholangiocarcinoma

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40
Q

Both PSC and PBC are associated with an increase in _ antibody

A

Both PSC and PBC are associated with an increase in IgM

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41
Q

Primary biliary cholangitis is _

A

Primary biliary cholangitis is autoimmune granulomatous destruction of intrahepatic bile ducts

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42
Q

PBC presents with _ ; _ is a late complication

A

PBC presents with obstructive jaundice ; cirrhosis is a late complication
* Pruritis, pale stools, dark urine (same as PSC)

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43
Q

PBC is commonly associated with _ and _ autoantibodies may be present

A

PBC is commonly associated with autoimmune disorders and anti-mitochondrial autoantibodies may be present

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44
Q

PSC tends to present in _ population

A

PSC tends to present in middle aged men

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45
Q

PBC tends to present in _ population

A

PBC tends to present in middle aged women

46
Q

(PBC/PSC) is associated with auto-mitochondrial antibodies

A

PBC is associated with auto-mitochondrial antibodies

47
Q

(PBC/PSC) is associated with p-ANCA

A

PSC is associated with p-ANCA

48
Q

Histology of primary biliary cholangitis will show _

A

Histology of primary biliary cholangitis will show lymphocytic infiltrate and granulomas

49
Q

(PBC/PSC) involves the intra AND extrahepatic bile ducts

A

PSC involves the intra AND extrahepatic bile ducts
* PBC only affects the intrahepatic bile ducts

50
Q

PBC causes an increased risk of _

A

PBC causes an increased risk of hepatocellular carcinoma
* Progression from chronic cirrhosis

51
Q

Secondary biliary cholangitis/cirrhosis is _

A

Secondary biliary cholangitis/cirrhosis is extrahepatic obstruction of the bile ducts –> causing duct fibrosis and bile stasis
* Associated with bile duct obstruction

52
Q

Chronic cholecystitis –> gallbladder calcification –> increase risk of _

A

Chronic cholecystitis –> gallbladder calcification –> increase risk of adenocarcinoma
* We call this a “porcelain gallbladder”

53
Q

_ is an adenocarcinoma of the bile duct epithelium

A

Cholangiocarcinoma is an adenocarcinoma of the bile duct epithelium

54
Q

Risk factors of cholangiocarcinoma include things that cause _

A

Risk factors of cholangiocarcinoma include things that cause chronic inflammation of bile duct epithelium
* Chronic cholecystitis
* Choledochal cysts
* PSC
* Clonorchis sinensis (Liver fluke)

55
Q

Cholangiocarcinoma is characterized by _ on histology

A

Cholangiocarcinoma is characterized by glands and mucin on histology (very disorganized)

56
Q

Cholangiocarcinoma presents with _

A

Cholangiocarcinoma presents with obstructive jaundice
* Pruritis, pale stool, dark urine

57
Q

Pruritus associated with jaundice occurs due to the build up of _

A

Pruritus associated with jaundice occurs due to the build up of bile salts

58
Q

Pale stools occur in obstructive jaundice due to the decrease in _

A

Pale stools occur in obstructive jaundice due to the decrease in stercobilin
* Decreased intestinal bilirubin

59
Q

Dark urine occurs in obstructive jaundice due to _

A

Dark urine occurs in obstructive jaundice due to increased conjugated bilirubin in blood
* Increase bilirubin going to the kidneys for excretion –> dark urine

60
Q

Jaundice is yellowing of the skin and sclera due to _ deposition

A

Jaundice is yellowing of the skin and sclera due to bilirubin deposition

61
Q

Conjugated jaundice most commonly occurs due to _

A

Conjugated jaundice most commonly occurs due to obstruction
* ie gallstones, cancers, Clonorchis sinensis, PBC, PSC

62
Q

Unconjugated jaundice most commonly occurs due to _

A

Unconjugated jaundice most commonly occurs due to hemolysis or enzyme deficiency

63
Q

Hepatitis and cirrhosis tend to cause a _ type jaundice

A

Hepatitis and cirrhosis tend to cause a mixed jaundice
* They impair enzymes and export

64
Q

Neonatal jaundice is caused by _

A

Neonatal jaundice is caused by immature UDP-glucuronosyltransferase (UDP-GT)
* Typically resolves within weeks of birth

65
Q

Babies at risk of kernicterus will need _ therapy

A

Babies at risk of kernicterus will need non-UV phototherapy

66
Q

Non-UV phototherapy treats newborn jaundice by _

A

Non-UV phototherapy treats newborn jaundice by increasing water solubility of bilirubin to increase excretion

67
Q

Bilirubin is a byproduct of _

A

Bilirubin is a byproduct of RBC breakdown
* Senescent RBCs (120 day lifespan) get broken down by macrophages into iron, globin, bilirubin

68
Q

Unconjugated bilirubin is water (soluble/insoluble)

A

Unconjugated bilirubin is water insolube; cannot be excreted in the urine

69
Q

Unconjugated bilirubin is (free/bound) in the blood

A

Unconjugated bilirubin is bound to albumin in the blood

70
Q

The enzyme that converts unconjugated bilirubin to conjugated bilirubin is _

A

The enzyme that converts unconjugated bilirubin to conjugated bilirubin is UDP-glucuronosyl-transferase
* Found in the liver

71
Q

Conjugated bilirubin is excreted from the liver as _ and goes into the intestine where gut bacteria turn it into _

A

Conjugated bilirubin is excreted from the liver as bile and goes into the intestine where gut bacteria turn it into urobilinogen

72
Q

Urobilinogen becomes _ (excreted in stool) and _ (excreted in urine)

A

Urobilinogen becomes stercobilin (excreted in stool) and urobilin (excreted in urine)

73
Q

Some pediatric jaundice is caused by improper formation of the bile ducts/ fibrosis and destruction of the extrahepatic bile ducts called _

A

Some pediatric jaundice is caused by improper formation of the bile ducts/ fibrosis and destruction of the extrahepatic bile ducts called biliary atresia
* Cholestasis can cause worsening jaundice, dark urine, pale stool, hepatomegaly
* Liver damage from high direct bilirubin

74
Q

G6PD deficiency can result in an increase in (conjugated/unconjugated) bilirubin

A

G6PD deficiency can result in an increase in unconjugated bilirubin
* Recall that G6PD converts NADP –> NADPH which protects RBCs from ROS damage
* Deficiency leads to RBC hemolysis

75
Q

All hereditary hyperbilirubinemias have _ inheritance

A

All hereditary hyperbilirubinemias have autosomal recessive inheritance

76
Q

_ is a condition of reduced UDP-GT that causes an increase in unconjugated bilirubin and jaundice during stress, fasting, illness

A

Gilbert syndrome is a condition of reduced UDP-GT that causes an increase in unconjugated bilirubin and jaundice during stress, fasting, illness

77
Q

Crigler-Najjar syndrome is caused by _

A

Crigler-Najjar syndrome is caused by absent UDP-GT
* Leads to severe jaundice, kernicterus

78
Q

Kernicterus is caused by _

A

Kernicterus is caused by basal ganglia bilirubin deposition

79
Q

We treat Crigler-Najjar syndrome with _ and _

A

We treat Crigler-Najjar syndrome with plasmapheresis and phototherapy
* Increase polarity and water solubility to increase excretion

80
Q

The curative treatment for Crigler-Najjar is _

A

The curative treatment for Crigler-Najjar is liver transplant

81
Q

Type II Crigler-Najjar is a more (severe/mild) form

A

Type II Crigler-Najjar is a more mild form

82
Q

Type II Crigler-Najjar can be treated with _

A

Type II Crigler-Najjar can be treated with phenobarbital

83
Q

Phenobarbital improves jaundice by _

A

Phenobarbital improves jaundice by increasing liver enzyme synthesis

84
Q

Dubin-Johnson syndrome is a hyperbilirubinemia condition caused by _

A

Dubin-Johnson syndrome is a hyperbilirubinemia condition caused by impaired liver excretion of conjugated bilirubin

85
Q

_ is a benign condition notable for black liver due to accumulated epinephrine metabolites

A

Dubin-Johnson syndrome is a benign condition notable for black liver due to accumulated epinephrine metabolites

86
Q

Rotor syndrome is caused by _

A

Rotor syndrome is caused by impaired hepatic uptake/excretion of conjugated bilirubin
* A milder version of Dubin-Johnson without a black liver

87
Q
A

Common bile duct

88
Q

ALT, AST, ALP, bilirubin will be (normal/elevated) in cholecystitis

A

ALT, AST, ALP, bilirubin will be normal in cholecystitis

89
Q

_ is often asymptomatic; stones are just sitting in the gallbladder

A

Cholelithiasis is often asymptomatic; stones are just sitting in the gallbladder

90
Q

Biliary colic is when _

A

Biliary colic is when stones intermittently obstruct the gallbladder neck/cystic duct, causing transient episodes of pain/discomfort

91
Q

_ is when a stone gets wedged in the cystic duct causing inflammation of the gallbladder

A

Acute cholecystitis is when a stone gets wedged in the cystic duct causing inflammation of the gallbladder

92
Q

Cholecystitis is associted with (colicky/ persistent) pain

A

Cholecystitis is associted with persistent pain

93
Q

_ occurs when a stone gets impacted in the common bile duct causing bile to back up into the hepatic bile ducts and LFTs to go up

A

Choledocholithiasis occurs when a stone gets impacted in the common bile duct causing bile to back up into the hepatic bile ducts and LFTs to go up

94
Q

_ is a progression of choledocholithiasis in which bile fluid gets infected from the obstruction

A

Ascending cholangitis is a progression of choledocholithiasis in which bile fluid gets infected from the obstruction

95
Q

We manage biliary colic via _

A

We manage biliary colic via observation, elective cholecystectomy

96
Q

Acute cholecystitis will have an elevation in (WBC/LFTs)

A

Acute cholecystitis will have an elevation in WBCs
* Liver enzymes will be normal

97
Q

Imaging of acute cholecystitis may show _

A

Imaging of acute cholecystitis may show stones, gallbladder wall thickening and pericholecystic fluid

98
Q

We treat acute cholecystitis with _

A

We treat acute cholecystitis with urgent cholecystectomy

99
Q

Of the gallstone pathologies, _ and _ are most certain to elevate liver enzymes

A

Of the gallstone pathologies, choledocholithiasis and cholangitis are most certain to elevate liver enzymes
* Gallstone pancreatitis (stone at the ampulla of vater) may or may not have elevated LFTs

100
Q

Choledocholithiasis and ascending cholangitis are treated with _

A

Choledocholithiasis and ascending cholangitis are treated with urgent ERCP, then cholecystectomy

101
Q

Autoimmune hepatitis is often positive for…

A
  • Positive anti-nuclear antibody (ANA)
  • Positive anti-smooth muscle antibody
  • Positive anti-liver-kidney microsomal Ab
  • Elevated IgG
102
Q

Autoimmune hepatitis will reveal _ on histology

A

Autoimmune hepatitis will reveal plasma cells and mononuclear infiltrates around the portal triad on histology

103
Q

(ALP/GGT) comes from liver and bones

A

ALP comes from liver and bones
* GGT only comes from hepatocytes

104
Q

Differential for elevated ALP and GGT

A

Differential for elevated ALP and GGT:
* Biliary obstruction (stone, tumor)
* Biliary disease (PSC, PBC)
* Infiltrative disease invading bile duct (sarcoidosis, lymphoma)
* Medications

105
Q

(PBC/PSC) is associated with intense pruritus

A

PBC is associated with intense pruritus

106
Q

(PBC/PSC) is associated with recurrent biliary obstructions/infections (cholangitis)

A

PSC is associated with recurrent biliary obstructions/infections (cholangitis)

107
Q

(PBC/ PSC) will have positive ANA

A

PBC will have positive ANA

108
Q

We can treat PBC with _ , a medication which changes the composition of bile

A

We can treat PBC with ursodeoxycholic acid , a medication which changes the composition of bile

109
Q
A

PBC

110
Q

(PBC/PSC) has granulomas

A

PBC has granulomas
* Spillage of bile –> macrophages try to contain

111
Q
A

PSC

112
Q
A

PSC

GI (13 decks)

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