Gallbladder

Question 0

Children

Answer 0

More likely to be pigmented stones from;

• Hemolytic disease (sickle, spherocytosis, G6PD)
• Chronic disease (nutrition, burns, trauma)

Question 1

Gallstones

Answer 1

smaller stones are more likely to be symptomatic than larger ones.
Acute attack often is precipitated by a lager or fatty meal.

Question 2

Colicky pain

Answer 2

pts tend to move around to seek relief from the pain.

each colic is about 1-5hrs.

Question 3

Stone location- lab

Answer 3

High AST/ALT: Common bile duct
Bilirubin level greater than 3.5mg/dL: Common bile duct or ascending cholangitis
High Amylase/ Lipase: Gallstone pancreatitis

Question 4

Cholestrol stones

Answer 4

Large and Yellowish

Question 5

Complications- Biliary colic and cholecystitis

Answer 5

Cholangitis
Sepsis
Pancreatitis
Gallbladder perforation
Empyema of GB
Emphysematous GB
GB hydrops
Gallstone ileus
Hepatitis
Choledocholithiasis

Question 6

Gallbladder perforation

Answer 6

When perforation is localized, it may be seen as pericholecystic fluid by U/S

Question 7

U/S and Nuclear medicine studies

Answer 7

Gold standard studies for the diagnosis of both cholecystitis and cholelithiasis
Stones have “Posterior shadowing” or intraluminal densities.

Question 8

Porcelain GB

Answer 8

10-30% of stones have a ring of calcium so they are Radiopaque

Question 9

CT

Answer 9

Since bile is the same density as the stones, they miss dx by 20%. Not gooood.

Question 10

Biliary scintigraphy (HIDA), nuclear medicine studies

Answer 10

90-100% for dx acute cholecystitis

In a typical normal study, the GB, common bile duct, and small bowel fill within 30-45mins.

Question 11

Endoscopic Retrograde Cholangiopancreatography (ERCP)

Answer 11

U/S is merely 50-70% sensitive for choledocholithiasis. when a dilated common bile duct or elevated LFTs are present, ERCP should be considered.
Diagnostic and therapeutic by direct removal of stones.

Question 12

Tx

Answer 12

Cholecystectomy: after the first 48hrs or after the inflammation has subsided.
Unstable pts: more urgent interventions like ERCP, percutaneous drainage, Cholecystectomy.
ERCP is followed by laproscopic cholecystectomy

Question 13

Carcinoma of the GB

Answer 13

Predominantly affects older persons with long-standing cholecystolithiasis.
60% in the fundus of GB.
No established tx protocol exists. 
U/S (GOLD STANDARD)
CT is useful in staging the tumor.