Gallbladder and Biliary Tract

Question 1

Jaundice

Answer 1

First shows up in the sclera of the eye at Bilirubin =4

Question 2

Hereditary Hyperbilirubinemia - at the level of the hepatocyte

Answer 2

.1. Gilbert’s syndrome - low GT

2. Crigler-Najar: type 1 - no GT and; type 2 -very low GT
3. Dubin-Johnson and Rotor syndrome

Question 3

Intra - hepatic Cholestasis

Answer 3

Intrinsiv liver disease

Defect in secretion of bile across canalicular membrane

Question 4

Extra-hepatic cholestasis

Answer 4

Obstruction of bile ducts = increase in direct bilirubin

–> gallstones, strictures (inflammatory,, malignant), neoplasia (benign, malignant), parasites (clonorchis senensis)

Question 5

Cholethiasis

Answer 5

m

Question 6

Acute cholecystitis

Answer 6

.

Question 7

Chronic cholecystitis

Answer 7

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Question 8

Porcelain gallbladder

Answer 8

.

Question 9

Cholesterolosis

Answer 9

.

Question 10

Choledocholithiasis

Answer 10

.

Question 11

Asceninding cholangitis

Answer 11

.

Question 12

Acute acalculous cholecystitis

Answer 12

.

Question 13

Neoplasia

Answer 13

.

Question 14

Primary Sclerosing cholangitis

Answer 14

.

Question 15

Secondary sclerosing cholangitis

Answer 15

.

Question 16

choledochal cysts

Answer 16

.

Question 17

cholangiocarcinoma

Answer 17

.

Question 18

Benign and malignant neoplasia

Answer 18

.

Question 19

Gall bladder disease and pregancy

Answer 19

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Question 20

Diagnosis of gallstone disease

Answer 20

Labs
Presentation = RUQ/epigastric pain, sudden, postprandial sometimes, nausea/vomiting, preceding pain attacks - exceptions: old age, immune deficient, poorly controlled diabetics..etc
Imaging

Question 21

Management of gallstone disease

Answer 21

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Question 22

Composition of Bile

Answer 22

Bile acids (drive bile flow), phospholipids, cholesterol, bilirubin, ions, water (solvent drag)
Bile is the only way to get rid of cholesterol --> transformation to bile acids

Question 23

Control of Bile secretion

Answer 23

Secretion of bile is an active process

Question 24

Enterohepatic secretion of bile acids

Answer 24

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Question 25

Components of the biliary tract

Answer 25

Hepatocyte –> canaliculi –>

Question 26

Hepatic architecture

Answer 26

First part that gets congested.?
Isolated INR –> hepatic congestion
tight gap junctions to prevent leaking bile out
Liver failure destroys the gap junction –> jaundice

Question 27

Clinical Criteria and Labs for Cholestasis

Answer 27

Clinical Criteria
1. Jaundice
2. Pruritis
Labs:
- High bilirubin and high ALP (cholestasis), high GGT
- High cholesterol, xanthomas
- Malabsorption of fats and fat-soluble vitamins

Question 28

What do ALT and AST tell you?

Answer 28

Also AST and ALT –> destruction at the level of the hepatocyte
GGT and ALP should be elevated. If the GGT is not elevated - then the ALP is coming from elsewhere.

Question 29

Liver function indicators

Answer 29

factor 7 - INR

albumin