Gallbladder and Biliary Tract

Question 1

What is biliary atresia?

Answer 1

Failure to form or early destruction of the lumen of the extrahepatic biliary tree leading to biliary obstruction and progression to liver cirrhosis

Question 2

What is cholelithiasis?

Answer 2

Solid, round stones in the gallbladder due to precipitation of cholesterol or bilirubin

Question 3

How are stones formed in the gallbladder?

Answer 3

-Supersaturation of cholesterol and bilirubin due to decrease phospholipids (that helps solubilize cholesterol) and decrease bile acids that also increase solubility of bilirubin. Stasis can lead to growth of bacteria that can deconjugate bile and leads to bilirubin stone formation

Question 4

What is the most common type of gallbladder stone?

Answer 4

Cholesterol stones. Are usually radiolucent, so cannot be seen on xray unless they are associated with calcium.

Question 5

What are the risk factors for development of cholesterol gallbladder stone?

Answer 5

• Age (40yo))
• Estrogen (Female, obesity, multiple pregnancies, OCPs)
• Clofibrate -lipid lowering aging that decreases bile acids and increases cholesterol
• Native American ethnicity
• Crohn Disease
• Cirrhosis

Question 6

What type of gallbladder stones are radiolucent and which are radioopaque?

Answer 6

• Radiolucent –> Cholesterol stones

- Radioopaque –> Bilirubin stones

Question 7

What are the risk factors for bilirubin stones?

Answer 7

Extravascular hemolysis, biliary tract infection

Question 8

What are the 6 key complications/conditions that can result from gallstones?

Answer 8

• Biliary colic
• Cholecystitis
• Choledocolithiasis
• Ascending Cholangitis
• Gallbladder Ileus
• Gallbladder Cancer

Question 9

What is acute cholecystitis?

Answer 9

Acute inflammation of the gallbladder wall

Question 10

What causes cholecystitis?

Answer 10

Impacted stone in the cystic duct results in gallbladder dilation with pressur ischemia, serving as a nidus for bacterial overgrowth (especially E.coli), and inflammation.

Question 11

What are the clinical features of cholecystitis?

Answer 11

Epigastric/RUQ pain that often radiates to the R scapula, fever with leukocytosis, nausea, vomiting, and increase Alk Phos from duct damage

Question 12

What is the risk of NOT treating cholecystitis?

Answer 12

RUPTURE

Question 13

What is chronic cholecystitis?

Answer 13

Chronic inflammation of the gallbladder wall

Question 14

What causes chronic cholecystitis?

Answer 14

Chemical irritation form longstanding cholelithiasis w/wo superimposed bouts of acute cholecystitis

Question 15

What characterizes chronic cholecystitis?

Answer 15

Herniation of gallbladder mucosa into the muscular wall (Rokitansky-Aschoff sinus)

Question 16

What is a late complication of chronic cholecystitis?

Answer 16

Procelain gallbladder - shrunken, hard gallbladder due to chronic inflammation, fibrosis, and dystrophic calcification. Increases the risk for carcinoma

Question 17

What is the treatment for cholecystitis?

Answer 17

Lap or open cholecystectomy

Question 18

What is ascending cholangitis?

Answer 18

Bacterial infecition of the bile ducts typically due to an obstructing stone allowing for the ascension of enteric gram negative bacteria.

Question 19

What are the features of cholangitis?

Answer 19

• Charcot’s triad: RUQ pain, jaundice and fever

- Reynaud’s Pentad: Charcot’s triad, hypotension, altered mental status

Question 20

What is gallstone ileus?

Answer 20

When a gallstone enters and obstructs the small bowel. Often in the setting of cholecystitis with fistula formation between the gallbladder and small bowel allowing the passage of large stones from the Gb into the small bowel that is capable of causing an SBO

Question 21

What is gallbladder carcinoma?

Answer 21

Adenocarcinoma arising from the glandular epithelium that lines the gallbladder wall with major risk factor being gallstones

Question 22

How does gallbladder carcinoma classically present?

Answer 22

Cholecystitis in an elderly woman. Poor prognosis