Gallbladder and Bile Duct Flashcards by O.K .

Which one is the most important factor in gall clearence?

A)  	gastrin
B)  	nitrogen monoxide
C)  	secretin
D)  	cholecystokinin
E)  	VIP

D) cholecystokinin

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Which one is the most frequent gallstone?

A) Cholesterol stone
B) Bilirubin stone
C) Mixed stone
D) Oxalate stone

A) cholesterol

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Which symptom is not characteristic to disorders of biliary excretion?

A)  	abdominal distension
B)  	”fullness” feeling
C)  	severe steatorrhoea
D)  	abdominal discomfort
E)  	pain under the right ribs

C) severe steatorrhea

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How often is the outlet of the ductus choledochus and the ductus pancreaticus joint (Ampulla of Vater)?

A)  	10%
B)  	30%
C)  	50%
D)  	70%
E)  	90%

E) 90%

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Which of the following agents facilitate biliary excretion?

1) CCK
2) secretin
3) bile salts
4) adrenalin

A)  	1st, 2nd and 3rd answers are correct
B)  	1st and 3rd answers are correct
C)  	2nd and 4th answers are correct
D)  	only 4th answer is correct
E)  	all of the answers are correct

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Which are the factors predisposing to gallstone formation?

1) pregnancy
2) sudden dieting
3) meal rich in unsaturated fatty acids
4) resection of the small intestine

A)  	1st, 2nd and 3rd answers are correct
B)  	1st and 3rd answers are correct
C)  	2nd and 4th answers are correct
D)  	only 4th answer is correct
E)  	all of the answers are correct

E) all

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What is the procedure to choose in case of incidentally discovered gallstones not causing any symptomes?

1) surgical removal of the gallbladder
2) lithotripsy performed with ultrasound
3) starting a lasting gallstone solubilizer medication
4) informing the patient of the gallstones and personalized therapeutic consideration

A)  	1st, 2nd and 3rd answers are correct
B)  	1st and 3rd answers are correct
C)  	2nd and 4th answers are correct
D)  	only 4th answer is correct
E)  	all of the answers are correct

4 only

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Which of the following does decrease the spasm of the Oddi sphincter?

1) nitrates
2) chocolate
3) cholecystokinin
4) morphine

A)  	1st, 2nd and 3rd answers are correct
B)  	1st and 3rd answers are correct
C)  	2nd and 4th answers are correct
D)  	only 4th answer is correct
E)  	all of the answers are correct

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What are the indications of endoscopic sphincterotomy?

1) choledocholithiasis
2) Oddi-sphincter-dyskinesis
3) acute recidive gallbladder attack resulting in acute pancreatitis
4) carcinoma of the pancreatic head

A)  	1st, 2nd and 3rd answers are correct
B)  	1st and 3rd answers are correct
C)  	2nd and 4th answers are correct
D)  	only 4th answer is correct
E)  	all of the answers are correct

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Which of the following procedures are useful for functional examination of the gallbladder?

1) liver scintigraphy
2) MRCP (magnetic resonance cholangiopancreatography)
3) intravenous urography
4) cholescintigraphy

A)  	1st, 2nd and 3rd answers are correct
B)  	1st and 3rd answers are correct
C)  	2nd and 4th answers are correct
D)  	only 4th answer is correct
E)  	all of the answers are correct

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Which enzyme of the bile contributes to fat digestion?

1) lipase
2) cholic acid
3) colipase
4) neither of the aforementioned

A)  	1st, 2nd and 3rd answers are correct
B)  	1st and 3rd answers are correct
C)  	2nd and 4th answers are correct
D)  	only 4th answer is correct
E)  	all of the answers are correct

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lipase and collipase aren’t in bile and bile acids are not emzymes

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What is the Courvoisier-sign?

1) pain under the right ribs + jaundice + fever
2) jaundice + melaena + epigastric pain
3) fever + jaundice + tactile resistance in the upper abdomen
4) tactile, not painful enlarged gallbladder

A)  	1st, 2nd and 3rd answers are correct
B)  	1st and 3rd answers are correct
C)  	2nd and 4th answers are correct
D)  	only 4th answer is correct
E)  	all of the answers are correct

only 4

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Which of the following diseases can cause direct hyperbilirubinaemia?

1) Gilbert’s syndrome
2) Rotor syndrome
3) haemolysis
4) choledocholithiasis

A)  	1st, 2nd and 3rd answers are correct
B)  	1st and 3rd answers are correct
C)  	2nd and 4th answers are correct
D)  	only 4th answer is correct
E)  	all of the answers are correct

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rotor syndrome: AR disease of the inhibition of secretion of conjugated bilirubin into bile

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What is the most important differentiating laboratory parameter in cases of obstructive jaundice?

1) elevated direct bilirubin
2) elevated total bilirubin
3) elevated urinary UBG
4) no UBG in the urine

A)  	1st, 2nd and 3rd answers are correct
B)  	1st and 3rd answers are correct
C)  	2nd and 4th answers are correct
D)  	only 4th answer is correct
E)  	all of the answers are correct

4 only

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Which statements are true regarding biliary functions and blood cholesterol levels?

1) Elevated biliary functions elevate blood cholesterol levels.
2) Elevated biliary functions decrease blood cholesterol levels.
3) Elevated biliary functions elevate LDL levels.
4) Bile is the only elimination route for cholesterol from the body.

A)  	1st, 2nd and 3rd answers are correct
B)  	1st and 3rd answers are correct
C)  	2nd and 4th answers are correct
D)  	only 4th answer is correct
E)  	all of the answers are correct

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Which of the following may be complication of gallstones?

1) obstructive jaundice
2) acute pancreatitis
3) cholecystitis
4) chronic pancreatitis

A)  	1st, 2nd and 3rd answers are correct
B)  	1st and 3rd answers are correct
C)  	2nd and 4th answers are correct
D)  	only 4th answer is correct
E)  	all of the answers are correct

E) all

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Solubizing the gallstone which is smaller than 2 cm and has been formed during pregancy is advised later, because pregnancy is only a temporary state predisposing to gallstone formation.

A) both the statement and the explanation are true and a causal relationship exists between them;
B) both the statement and the explanation are true but there is no causal relationship between them;
C) the statement is true, but the explanation is false;
D) the statement is false, but the explanation itself is true
E) both the statement and the explanation are false

A) both are right with relation

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All gallstones should be surgically removed, because gallstone is formed only in permanently functionally damaged gallbladders.

E) all wrong

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Sudden dieteing does not predispose to gallstone formation, because environment in non-functioning gallbladders favors gallstone formation.

D) part one is wrong but part two is correct

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Laparoscopic cholecystectomy is a lower load for the patient compared to open cholecystectomy, because the abdomen is not opened in a large surface.

A) both are right with relation

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Abdominal ultrasound examination can detect gallbladder carcinoma with great security, therefore gallbladdder carcinoma is usually detected at early stage.

E) it’s all wrong

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Gallstones are generated in the gallbladder, because in the gallbladder the concentration of the bile is at least fivefold.

A) both are right with relation

Treatment of chronic abdominal complaints occurring after cholecystectomy is easy, because in these cases with the introduction of antacid treatment most symptoms can be ceased.

E) both are false

Klatskin tumour can be easily removed surgically, because the tumour is located in the porta hepatis.

D) part one is false but part two is true

The common bile duct (ductus choledochus) usually leads to the duodenum through the minor papilla, because the duct of Wirsung leads to the duodenum through the ampulla of Vater. A) both the statement and the explanation are true and a causal relationship exists between them; B) both the statement and the explanation are true but there is no causal relationship between them; C) the statement is true, but the explanation is false; D) the statement is false, but the explanation itself is true E) both the statement and the explanation are false

D) part one is wrong but part two is right

Ultrasound scan detects bile duct stones with great certainty, because ultrasound is absolute reliable in the detection of gallbladder stones as well. A) both the statement and the explanation are true and a causal relationship exists between them; B) both the statement and the explanation are true but there is no causal relationship between them; C) the statement is true, but the explanation is false; D) the statement is false, but the explanation itself is true E) both the statement and the explanation are false

D) part one is wrong but part two is right gallbladder stones are easier to see than bile duct stones

The surgical solution of bile duct stenoses is advised, when the intervention with ERCP is unsuccessful, because surgical intervention is cheaper than stent exchanges. A) both the statement and the explanation are true and a causal relationship exists between them; B) both the statement and the explanation are true but there is no causal relationship between them; C) the statement is true, but the explanation is false; D) the statement is false, but the explanation itself is true E) both the statement and the explanation are false

C) part one is right but part two isn't

Prophylactic antibiotic therapy in obstructive jaundice decreases the complication rate of ERCP, because the assurance of free bile flow is of secondary importance. A) both the statement and the explanation are true and a causal relationship exists between them; B) both the statement and the explanation are true but there is no causal relationship between them; C) the statement is true, but the explanation is false; D) the statement is false, but the explanation itself is true E) both the statement and the explanation are false

C) part 1 is true but part two isn't

In case of gallstones the first choice of treatment is always medical stone dissolution, because it is cheap and only 10% of gallstones recur within two years. A) both the statement and the explanation are true and a causal relationship exists between them; B) both the statement and the explanation are true but there is no causal relationship between them; C) the statement is true, but the explanation is false; D) the statement is false, but the explanation itself is true E) both the statement and the explanation are false

E) both are wrong

Gallstone production is common in small bowel diseases, because in these cases the reabsorption of bile acids that keep the bile in solution is damaged. A) both the statement and the explanation are true and a causal relationship exists between them; B) both the statement and the explanation are true but there is no causal relationship between them; C) the statement is true, but the explanation is false; D) the statement is false, but the explanation itself is true E) both the statement and the explanation are false

A) both are correct with relation

What is the first choice of examination? A 45-year-old woman with known bile stones complains of a cramping, severe abdominal pain under the right ribs irradiating in the scapulae, beginning about 30 minutes after eating and associated by nausea. During physical examination she indicates a strong pain on pressure under the right ribs, and fluctuating resistance can be felt here. ``` A) abdominal CT B) stomach X-ray C) gastroscopy D) abdominal US E) chest X-ray ```

D) abd US

What lab test helps setting the correct diagnosis? A 45-year-old woman with known bile stones complains of a cramping, severe abdominal pain under the right ribs irradiating in the scapulae, beginning about 30 minutes after eating and associated by nausea. During physical examination she indicates a strong pain on pressure under the right ribs, and fluctuating resistance can be felt here. 1) white blood cell count 2) serum-amylase 3) total urine 4) direct bilirubin ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

E) all

What is the most probable diagnosis? A 45-year-old woman with known bile stones complains of a cramping, severe abdominal pain under the right ribs irradiating in the scapulae, beginning about 30 minutes after eating and associated by nausea. During physical examination she indicates a strong pain on pressure under the right ribs, and fluctuating resistance can be felt here. ``` A) acute pancreatitis B) gallstone ileus C) gastric perforation D) hydrops vesicae felleae E) choledocholithiasis ```

D) hydrops vesicae felleae aka inflammed glalbladder bc of stones

What therapuetic interventions are considered? A 45-year-old woman with known bile stones complains of a cramping, severe abdominal pain under the right ribs irradiating in the scapulae, beginning about 30 minutes after eating and associated by nausea. During physical examination she indicates a strong pain on pressure under the right ribs, and fluctuating resistance can be felt here. 1) inserting a central venous catheter and administering nitrates 2) laparoscopic cholecystectomy 3) endoscopic sphincterotomy and stone extraction 4) complete fasting, conservative medical treatment ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

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What is the next examination of choice? A 78-year-old man is admitted to the hospital because of significant weight loss and jaundice. Abdominal US confirms a gallbladder without stone and dilated intrahepatic bile ducts, the extrahepatic bile ducts are not wider. A) iv. cholescintigraphy B) abdominal CT C) ERCP D) percutaneous transhepatic drainage

C) ERCP

Which laboratory results help in setting the diagnosis? A 78-year-old man is admitted to the hospital because of significant weight loss and jaundice. Abdominal US confirms a gallbladder without stone and dilated intrahepatic bile ducts, the extrahepatic bile ducts are not wider. 1) normal CRP level 2) elevated erythrocyte sedimentation rate 3) high LDH level 4) elevated CEA level ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

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What is the most probable diagnosis? A 78-year-old man is admitted to the hospital because of significant weight loss and jaundice. Abdominal US confirms a gallbladder without stone and dilated intrahepatic bile ducts, the extrahepatic bile ducts are not wider. ``` A) acute cholecystitis B) acute hepatitis C) primary biliary cirrhosis D) bile duct tumour (Klatskin) E) pancreas head carcinoma ```

D) bile duct tumour (Klatskin)

What is the treatment of choice? A 78-year-old man is admitted to the hospital because of significant weight loss and jaundice. Abdominal US confirms a gallbladder without stone and dilated intrahepatic bile ducts, the extrahepatic bile ducts are not wider. ``` A) bypass surgery B) ERCP, stent implantation C) duodenal tube D) treatment with ursodeoxycholic acid E) bedrest, supportive treatment ```

B) ERCP, stent

Typical symptoms of Caroli syndrome: 1) recurring cholangitis 2) haematuria 3) shaking chills, fever 4) peptic duodenal ulcer ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

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Morphological characteristics of Caroli syndrome: 1) fusiform dilation of intrahepatic bile ducts 2) crooked cystic duct 3) bile duct stenosis 4) shortened common bile duct ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

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Criterion of early cholecystectomy in case of gallstones: 1) jaundice 2) previous abdominal operation 3) cholangitis not responding to antibiotics 4) within 24-72 hours after the formation of symptoms ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

Criterion of the solution of gallstones with bile acids: 1) permeable cystic duct 2) calcareous gallbladder 3) well contracting gallbladder 4) age above 50 years ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

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Characteristics of gallbladder polyps: 1) 95 percent are benign 2) can be detected with ultrasound 3) adenomas larger than 10 mm are precancerous 4) inflamed polyps are common ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

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Characteristics of Mirizzi’s syndrome: 1) obstructive icterus 2) normal bilirubin level 3) dilated hepatic duct 4) diarrhoea ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

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Possible cause of gallbladder hypokinesia: 1) diabetes 2) extended starvation 3) pregnancy 4) steroid treatment ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

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It can be typical symptom of tumour of the ampulla of Vater: 1) jaundice 2) fever 3) pruritus 4) diarrhoea ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

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Possible symptom of postcholecystectomy syndrome: 1) constipation 2) weight loss 3) nausea 4) diarrhoea ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

Possible cause of postcholecystectomy syndrome: 1) cystic duct remnant syndrome 2) bile duct stenosis 3) remaining bile duct stone 4) gallstone ileus ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

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Characteristics of cholelithiasis: 1) can be detected in 10 percent of the population 2) more common in women than in men 3) its incidence increases with age 4) its prevalence does not change with age ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

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Characteristics of juxtapapillary diverticulum: 1) can be cause of chronic liver disease 2) endoscopic papillotomy is contraindicated 3) is often associated with bile duct malformations 4) raises the risk of bile duct stones ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

The most common location of obstruction in gallstone ileus: 1) hepatic flexure 2) colonic diverticulum 3) duodenal diverticulum 4) ileocecal valve ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

Predisposing factors of acute acalculous cholecystitis, except: 1) prolonged starvation 2) immobility 3) hemodynamic instability associated with severe abdominal diseases 4) nonalcoholic steatohepatitis ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

It may be the complication of choledocholithiasis: 1) chronic cholangitis 2) biliary pancreatitis 3) secondary biliary cirrhosis 4) liver cyst ``` A) 1st, 2nd and 3rd answers are correct B) 1st and 3rd answers are correct C) 2nd and 4th answers are correct D) only 4th answer is correct E) all of the answers are correct ```

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