Gallbladder/bile ducts/pancreas - Kaplan

Question 1

What are two types of gallstones?

Answer 1

Cholesterol stones (80% of stones in the US)
Pigment stones (20% of stones in the US)

Question 2

9/10 cases of acute cholecystitis are caused by?

Answer 2

Choleliths

Question 3

4/10 cases of acute pancreatitis are caused by?

Answer 3

Choleliths

Question 4

At what rate are gallstones symptomatic?

Answer 4

2% per year.

Question 5

An asian with a biliary infection (for example a parasite) will be more likely to have which type of gallstone?

Answer 5

Pigment stone

Question 6

What is gallstone ileus?

Answer 6

Gallstones passing from the gallbladder through the small intestine (and causing blockage?). Gallstones impact throughout the small intestine, with higher rates near the terminal ileum.

Question 7

What is the pathophysiology of cholelith-based acute cholecystitis?

Answer 7

Mechanical obstruction of the bile duct PLUS mucosal irritation and destruction from the remaining gallstones (mucosal damage–> enzyme release–> inflammation). This leads to distension, ischemia or hemorrhage, and a vicious cycle of inflammation.

Question 8

What differentiates acute from chronic cholecystitis?

Answer 8

Chronic cholecystitis is a “histopathologic term for INFLAMMATION and FIBROSIS of the gallbladder”

Correlation with clinical symptoms is poor.
Correlation with gallstones is 95% (ie 95% of ppl with chronic cholecystitis will have gallstones)

Pathophysiology is not well understood.

Question 9

Gallbladder carcinoma is very (common OR rare) and has a (dismal OR good) prognosis.

Answer 9

Rare, dismal

1% @ 5 years.

Question 10

What are two major risk factors for gallbladder carcinoma?

Answer 10

Gallstones
Liver flukes (chronic infection)

Question 11

By far the most common type of gallbladder carcinoma is _____.

The worst (they are all terrible) is ______.

Answer 11

Adenocarcinoma.

Small cell.

Question 12

An infiltrative, gland forming neoplasm in the wall of the gallbladder would be a finding indicative of ____.

Answer 12

Adenocarcinoma.

Question 13

The major cause of ascending cholangitis is _____.

Answer 13

Choledocholithiasis.

Question 14

Choledocholith definition?

Answer 14

“Bile duct stone”

Stone within the biliary tree. Can drop from the gallbladder (90%) or arise within the duct (10%).

Question 15

What is a choledochal cyst?

Answer 15

A congenital dilatation of the common bile duct. Typically present in young patients (biliary obstruction–> jaundice, etc).

There are many classified types, based on the number, size, location.

Question 16

Bile duct carcinoma are (rare OR common) and are nearly all what type?

Answer 16

Very rare, adenocarcinoma.

Question 17

What are risk factors for bile duct carcinoma?

Answer 17

Choledochal cyst in adult (which is why these are repaired in kids)
Primary sclerosing cholangitis
Infections (liver flukes)

Question 18

4 sequelae of pancreatitis.

Answer 18

Pseudocysts
Secondary Diabetes
Pancreatic insufficiency
Abscesses

Question 19

What is the pathogenesis of acute pancreatitis caused by a cholelith?

Answer 19

Not simply due to mechanical obstruction.

Gallstone causes and increase in intraductal pressure (trapping of enzyme rich fluids). Causes backflow into the pancreatic parenchyma, leads to activation of proenzymes and tissue injury, inflammation, edema, ischemia, etc.

Question 20

What is the pathogenesis of acute pancreatitis caused by alcohol?

Answer 20

Alcohol causes increased secretion, as well as contraction of the sphincter of Oddi. Combination of increased stimulation and contraction of sphincter causes back pressure, similar to the gallstone picture.

Alcohol also causes mis-packaging of the pre-enzymes.

Question 21

Irreversible parenchymal destruction and fibrosis of the pancreas is called ____.

Causes?

Answer 21

Chronic pancreatitis

Alcohol abuse (majority)
Longstanding duct obstruction
Idiopathic (40%)
hereditary forms

Question 22

95% of all pancreatic tumors are ____.

Answer 22

Ductal adenocarcinoma.

2% = endocrine neoplasms
3% = other

Question 23

Gastrinoma, a pancreatic endocrine neoplasm, will often present with____.

Answer 23

Gastric ulcers. Gastrin increases acid secretion.

Zollinger-Ellison syndrome