Gallbladder

Question 1

What is the function of the gallbladder?

Answer 1

To store and concentrate bile 5 to 20 fold

Secrete bile into duodenum

Question 2

What is the most abundant solute in bile?

Answer 2

Bile salts

Question 3

What is bile?

Answer 3

medium for excretion of bilirubin and cholesterol

Question 4

How much bile does the liver secrete a day?

Answer 4

1 L

Question 5

What is the function of bile?

Answer 5

fat emulsification and absorption

Question 6

What are bile salts?

Answer 6

amphipathic solutes in bile that:
Emulsify lipids
Transport lipids to intestinal wall via micelles

Question 7

What causes the release of cholecystokinin and secretin?

Answer 7

Acidic, fatty chyme entering duodenum

Question 8

What cells secrete cholecystokinin and secretin?

Answer 8

Enteroendocrine cells of duodenum

Question 9

What is cholelithiasis?

Answer 9

presence of gallstones within the common bile duct

Question 10

What are the three classes of gallstones?

Answer 10

1. Pure cholesterol stones containing 90% cholesterol
2. Pigment stones composed predominantly of bilirubin
3. Mixed composition stones varying proportions of cholesterol, bilirubin as calcium carbonate, and calcium phosphate

Question 11

What are the major risk factors for cholelithiasis?

Answer 11

Age and Sex = >40
Environmental factors = estrogen exposure
Acquired disorders = galldbladder stasis
Hereditary factors = ATP-binding casettes

Question 12

What four conditions contribute to the formation of cholesterol gallstones?

Answer 12

1. supersaturation of bile with cholesterol
2. hypomotility of the gallbladder
3. defective conversion of cholesterol to bile acids
4. hypersecretion of mucus in the gallbladder

Question 13

What is the pathogenesis behind pigment gallstones?

Answer 13

1. elevated levels of unconjugated bilirubin in bile, seen in bacterial contamination of the biliary tree
2. infection of the biliary tract with E. coli

Question 14

What are the clinical features of cholelithiasis?

Answer 14

1. 70-80% of patients are asymptomatic throughout their life
2. Biliary colic that can become excruciating
3. pain localized to RUQ or epigastrium that may radiate to the right shoulder or the back
4. Inflammation of gallbladder generating pain

Question 15

What is cholecystitis?

Answer 15

inflammation of the gallbladder

Question 16

What are the three types of Cholecystitis?

Answer 16

Acute calculous Cholecystitis
Acalculous Cholecystitis
Chronic Cholecystitis

Question 17

What is acute calculous cholecystitis?

Answer 17

Precipitated in 90% of cases by obstruction of the neck or the cystic duct by a stone

Caused by chemical irritation and inflammation of the stone

Question 18

What is the pathogenesis behind acute calculous cholecystitis?

Answer 18

Normally protective glycoprotein mucus layer is disrupted, exposing the mucosal epithelium to the direct detergent action of the bile salts

Prostaglandins released within the wall of the gallbladder contribute to mucosal and wall inflammation

Question 19

What is the pathogenesis behind acute acalculous cholecystitis

Answer 19

Ischemia

Question 20

What is Chronic cholecystitis and what is it associated with?

Answer 20

presence of gallstones

Results of mechanial irritation or recurrent attacks of acute cholecystitis leading to fibrosis and thickening of the gallbladder

Question 21

What are the four main categories of risk factors for gallbladder cancer?

Answer 21

Patient demographics = advanced age, female
Gallbladder abnormalities = cholelithiasis
Patient exposures = heavy metals, smoking
Infections = salmonella, H. pylori

Question 22

What is the common thread that ties gallstones or chronic infections together with gallbladder cancer is?

Answer 22

Chronic inflammation

Question 23

What is the pathogenesis of gallbladder cancer?

Answer 23

Cholelithiasis = chronic irriation of gallbladder mucosa

Anomalous pancreaticobiliary duct junction = KRAS and p53 mutations