Gallbladder Flashcards
1
Q
- solid, round stones in the gallbladder
- due to precipitation of cholesterol (cholesterol stones) or bilirubin (bilirubin stones) in bile
- no cancer risk, unless complication
- DX: abdominal ultrasound (b/c 90% are radiolucent)
Arises with:
- supersaturation of cholesterol or bilirbuin
- decreased phospholipds or bile acids (which help solubilize the cholesterol), or
- stasis
Clinical features:
- Asymptomatic
- Symptomatic
- Pain
- Acute Inflammation
- Chronic Inflammation
- Obstruction
- Acute Pancreatitis
- Ileus: obstruction of bowels by gallstones
A
Cholelithiasis
2
Q
Gallblader releases its bile via CYSTIC DUCT
- Cystic duct joints Common Hepatic Duct to form the COMMON BILE DUCT
- Common bile duct enters the pancreatic head to joint with the Pancreatic Duct –> forms the Sphincter of Oddi
A
Ducts
3
Q
- Female:Male Ratio 2:1
- Oral contraceptives
- Child-Bearing
- Obesity/Rapid Wt.Loss
- Certain Ethnic Groups (Native American)
A
Risk factors for Cholelithiasis
4
Q
- predominantly formed in the gallbladder
- content is >50% cholesterol, but lower pigment (color is typically white)
- Formation: cholesterol combines with mucin
- Radiolucent (don’t show on X-ray)
- risk factors: age (40’s); Estrogen (birth control); obese patient who rapidly lost weight
A
Cholesterol Stones
5
Q
- formed within the common bile duct
- cholesterol:pigment ratio is 50:50
- believed to be due to infection from the duodenum or bowel retrograde into the bile duct
- acts as a nidus for stone formation
- usually radiopaque
A
Brown Pigment/Mixed Stone
6
Q
- Acute inflammation of the gallbladder wall, due to impacted stone in the cystic duct –> results in dilatation with pressure ischemia, bacterial overgrowth, and inflammation (neutrophilic)
- Usually RUQ pain or epigastric pain, often radiating to right scapula
- typically gets worse after fatty meal
- Can elicit Murphy’s sign
- risk of rupture if untreated
A
Acute Cholecystitis
7
Q
- Chronic inflammation of the gallbladder due to longstanding cholelithiasis and repeated episodes of acute inflammation
- Key Finding: Wall Thickening
- Rokitansky-Aschoff sinus: Herniation of gallbladder mucosa into muscular wall
- mostly lymphocytic infiltrate
- Sub-clinical
- Diminished Motility
- porcelain gallbladder is a late complication
- increased risk for carcinoma
A
Chronic Cholecystitis
8
Q
- Bacterial infection of the bile ducts
- usually due to ascending infection with enteric gram-negative bacteria
- Increased incidence with choledollithiasis (stone in biliary ducts), obstructing outflow, allowing bacteria to ascend
- presents as sepsis, jaundice and abdominal pain
- is a medical emergency
A
Cholangitis
9
Q
- Fever
- Jaundice
- Abdominal pain
A
Charcot’s Triad
10
Q
- Inflammation and hemorrhage of the pancreas, due to autodigestion of pancreatic parenchyma by pancreatic enzymes
- Can be due to gallstone obstruction at the ampulla; also due to alcohol
Clinical presentation:
- Epigastric abdominal pain that radiates to the back
- High Amylase
- High Lipase (more specifc to pancreatic damage)
- Sludge (due to stasis)
- Hypocalcemia
A
Acute Pancreatitis
11
Q
- Adenocarcinoma arising from the glandular epithelium that lines the gallbladder wall
Risk factors:
- Gall bladder wall thickening
- Non-function
- Scarring/contracture
- Calcification
- Adenomyosis
A
Gallbladder Carcinoma
12
Q
- measures emptying of the gallbladder and cystic duct flow (involves use of dye)
- Iminodiacetic acid is an anion that move from the plasma into bile like bilirubin.
A
HIDA SCAN
13
Q
- stone gets lodged in neck of gallbladder, which becomes so distended that it compresses the common hepatic duct
- causes dilation of intrahepatic ducts
- Can be mistaken for tumor at the common hepatic duct
A
Mirizzi’s Syndrome
14
Q
- do nothing (b/c mostly asymptomatic)
- surgery is only curative option
A
Treatment for Gallstones
15
Q
- Inflammation of intrahepatic small bile ducts leads to Cirrhosis
- Autoimmune
- 90% are Females; Age 40 to 60 yrs
Clinical:
- Asymptomatic
- *Incidental Elevated Alkaline Phosphatase
- Pruritis
- AST & ALT..Moderately elevated
- Jaundice at late stages
- Antibodies: AMA (90%); ANA (50%)
A
Primary Biliary Cirrhosis
