Gallbladder and Biliary Tract

Question 1

3 General Causes of Cholelithiasis

Answer 1

1. Supersaturation of chol or BR
2. Decreased phospholipids (lecithin) or bile acids, which normally increase solubility
3. Stasis (bacteria can deconjugate)

Question 2

Cholestyramine

Answer 2

Bile acid sequestrant that can increase risk of cholelithiasis

Question 3

Cholesterol Stones (epi, radiology, risk factors (main four and some others)

Answer 3

Most common stone esp. in West (>90%)
Radiolucent (usually, Some can be calcified)
Female, fertile, fat, forty. Female really from increased E so OCPs can do it too. Also Native Americans, Crohn’s, and cirrhosis because decreased bile salt production

Question 4

Bilirubin Stones (radiology and 2 risk factors)

Answer 4

Radioopaque
Extravascular hemolysis (extra BR in bile) and biliary tract infection

Question 5

5/6 Symptoms of Gallstones (even though usually asymptomatic)

Answer 5

Biliary Colic
Acute/Chronic Cholecystitis
Ascending Cholangitis
Gallstone Ileus

Question 6

Acute Cholecystitis Characteristic Pain and Possible Lab Finding

Answer 6

RUQ pain that radiates to RIGHT SCAPULA

Alk phos can be elevated from duct damage

Question 7

Chronic Cholecystitis Histo and Gross Finding, and symptom

Answer 7

Rokitansky-Aschoff sinus - herniation of gb mucosa into muscular wall
Porcelain gallbladder late complication from hard/shrunken/calcification
Vague RUQ pain, especially after eating

Question 8

Gallstone Ileus

Answer 8

Cholecystitis leads to fistula b/w gb and small bowel. Stones can get into small bowel and cause ileus

Question 9

Gallbladder Carcinoma classic presentation

Answer 9

Cholecystitis in a woman usually too elderly for normal