Gallbladder disorders

Question 1

Composition of pigment gallstones

Answer 1

Calcium salts and unconjugated bilirubin

Question 2

US shows highly reflective echoes with posterior acoustic shadowing. Pt switching to lateral decubitus shows motility.

Answer 2

Gallstones

Question 3

Complications of cholelithiasis

Answer 3

Cholecystitis
Empyema
Perforation
Cholangitis
Obstructive cholestasis
Pancreatitis
Gallbladder carcinoma
Bouveret syndrome

Question 4

Occurs occasionally, when a large gallstone erodes directly into an adjacent loop of the small bowel, generating an intestinal obstruction

Answer 4

Bouveret syndrome

Question 5

Common places for a gallstone to lodge in acute calculous cholecystitis

Answer 5

Gallbladder neck
Cystic duct

Question 6

Associated conditions that may cause acute acalculous cholecystitis

Answer 6

Major surgery/trauma
Sepsis
Burns
DM
Immunosuppression
Infection

Question 7

Pt presents with sudden RUQ pain radiating to R shoulder. US shows enlarged and edematous gallbladder with no gallstones. They have diabetes.

Answer 7

Acute acalculous cholecystitis

Question 8

Gallbladder empyema

Answer 8

Accumulation of pus, biliary sludge, and hemorrhage

Question 9

Gallbladder is transformed to a green-black necrotic organ

Answer 9

Gangrenous cholecystitis

Question 10

Complication of gangrenous cholecystitis

Answer 10

Perforation cause peritonitis

Question 11

Symptoms of chronic cholecystitis

Answer 11

Vague upper abdominal pain and intolerance for fatty foods

Question 12

Reactive epithelial proliferation with infolding within the muscularis of the mucosa of the gallbladder, and buried crypts of epithelium within the gallbladder wall

Answer 12

Rokitansky-Aschoff sinuses, associated with chronic cholecystitis

Question 13

Porcelain gallbladder

Answer 13

Extensive dystrophic calcification of the gallbladder wall

Question 14

Atrophic, chronically obstructed, often dilated gallbladder that may contain only clear secretions

Answer 14

Hydrops of the gallbladder

Question 15

Caused by rupture of Rokitansky-Aschoff sinuses and accumulation of macrophages with ingested biliary phospholipids (xanthoma cells)

Answer 15

Xanthogranulomatous cholecystitis

Question 16

Gallbladder appears shrunken, nodular, and chronically inflamed with a massively thickened wall. There are foci of necrosis and hemorrhage.

Answer 16

Xanthogranulomatous cholecystitis

Question 17

Charcot triad of cholangitis

Answer 17

Jaundice
Fever
RUQ pain

Question 18

Complications of hydrops of the gallbladder

Answer 18

Empyema
Perforation
Gangrene

Question 19

Caused by prolong cystic duct obstruction causing the bile in the gallbladder to be reabsorbed and replaced by a clear mucinous fluid.

Answer 19

Hydrops/mucocele of the gallbladder

Question 20

Risk increased with empyema

Answer 20

Sepsis
Perforation

Question 21

Symptoms of empyema

Answer 21

High fever
Severe RUQ
Marked leukocytosis
Prostration

Question 22

Reynold pentad of cholangitis

Answer 22

RUQ pain
Fever
Jaundice
Confusion
Shock

Question 23

Complications of choledocholithiasis

Answer 23

Cholangitis
Hepatic abscess
Chronic liver disease

Question 24

Precursor lesions of gallbladder caricnoma

Answer 24

Flat in site lesions with varying grades of dysplasia

Intracholecystic papillary tubular neoplasm

Intestinal metaplasia

Question 25

Most common location of gallbladder adenocarcinoma

Answer 25

Fundus

Question 26

Name of adenocarcinoma that occurs at the junction of the R and L hepatic ducts

Answer 26

Perihilar cholangiocarcinoma/Klatskin tumor

Question 27

Risk factors for extrahepatic cholangiocarcinoma

Answer 27

Gallstones
Inflammatory disease of colon
PSC
Liver fluke infestation
Hepatolithiasis