gallbladder pathophysiology

Question 1

components of bile

Answer 1

water, bile acids (active ingredient), cholesterol, phospholipids, lecithn, electrolytes

Question 2

Function of gallbladder and bile duct

Answer 2

gallbladder stores and concentrates bile when fasting, then contracts to deliver bile to duodenum. Ducts are route for excretion of cholesterol, minerals, drugs

Question 3

compare bile in the liver vs gallbladder

Answer 3

Bile is much more concentrated in gallbladder

Question 4

Control of gallbladder release

Answer 4

During fasting, PSNS vagal tone and CCK levels are decreased so sphincter of Oddi is closed. During eating, CCK and vagal tone increase, gallbladder and bile duct peristalsis, transport into duodenum

Question 5

Causes of gallstones

Answer 5

Too much cholesterol in bile, too little water, or both. Caused by gallbladder/bile duct dysmotility, hereditary mutations in cholesterol chain structure, or inflammation in the gallbladder.

Question 6

Types of gallstones

Answer 6

Cholesterol (white or yellow), brown (bacterial), or pigment stones (black and hard bile stasis)

Question 7

What causes cholesterol gallstones

Answer 7

genetic mutations in cholesterol side chains, bile acid hypersecretion, gallbladder stasis, or a combination

Question 8

What causes pigment stones

Answer 8

develop in patients with increased concentrations of bilirubin in the bile, especially those with hemolytic states such as sickle cell anemia. Also as result of stasis. More common in asians. Can develop in gallbladder or bile duct

Question 9

Chief component of pigment stones

Answer 9

calcium bilirubinate

Question 10

gallstones risk factors

Answer 10

5 Fs: obesity, female, age >30, family history, estrogen use, rapid weight loss, biliary obstruction

Question 11

Diagnosis of gallstones

Answer 11

abd ultrasound, or CT if cause of abd pain is unclear. For stones in bile duct, MRI of biliary tree (MRCP: magnetic resonance cholangiopancreatography) or endoscopic retrograde cholangiopancreatography (ERCP).

Question 12

gallstone treatment

Answer 12

endoscopic retrograde cholangiopancreatography (ERCP)

Question 13

Gallstone complications

Answer 13

biliary colic, acute cholecystitis, ascending cholangitis, gallstone pancreatitis, gallbladder carcinoma

Question 14

What is biliary colic

Answer 14

•Caused by movement of stone into cystic duct or gallbladder neck

Question 15

biliary colic symptoms

Answer 15

•Intermittent pain in epigastrium or RUQ. After meals, particularly fatty foods. Peaks in an hour, remits 3-8 hrs later

Question 16

biliary colic management

Answer 16

•Laparoscopic cholecystectomy is curative.

Question 17

Acute calculus cholecystitis

Answer 17

•Stone in cystic duct or gallbladder neck. Bacteria colonization, transmural inflammation. GB, perforation, sepsis or death may result if untreated

Question 18

Acute calculus cholecystitis presentation

Answer 18

–Severe pain in RUQ, nausea, fever. Murphys sign (pt stops exhaling on palpation of RUQ)

Question 19

Acute calculus cholecystitis treatment

Answer 19

NPO (rest), IV hydration, IV antibiotics, surgical removal of gallbladder, percutaneous drainage if too ill for surgery

Question 20

Acalculous cholecystitis

Answer 20

Usually from ischemia of gallbladder. Risk factors = sepsis, recent surgery, trauma/burns, hypotension.

Question 21

Choledocholithiasis

Answer 21

stones in bile ducts, most migrate from gallbladder.

Question 22

Choledocholithiasis symptoms

Answer 22

jaundice, dark urine, abd pain, acute pancreatitis

Question 23

Choledocholithiasis diagnosis and management

Answer 23

liver chemistries, ultrasound, MRCP or ERCP. Treatment: ERCP with extraction and/or lithotripsy, surgery if refractory

Question 24

Ascending cholangitis

Answer 24

Bacterial infection of bile duct. Almost always a complication of choledocholithiasis

Question 25

Ascending cholangitis symptoms

Answer 25

Charcots triad: fever, RUQ pain and jaundice. Sepsis or death may occur if untreated

Question 26

Ascending cholangitis management and diagnosis

Answer 26

history, labs, US are suggestive, but ERCP is definitive for diagnosis and management. Hospital admit NPO, broad spectrum IV Abx, IV fluids.

Question 27

Causes of benign biliary stricture

Answer 27

surgery, radiation, Primary sclerosing cholangitis (PSC), chronic pancreatitis, autoimmune pancreatitis, chronic choledocholithiasis

Question 28

Causes of malignant biliary stricture

Answer 28

Pancreatic cancer, Cholangiocarcinoma, Gallbladder cancer, Ampullary cancer

Question 29

Biliary stricture presentation

Answer 29

RUQ pain, cholestasis (jaundice, dark urine, acholic stools, pruritus),

Question 30

Biliary stricture labs

Answer 30

liver function tests elevated. Alk phos/GGT, bilirubin&raquo_space; ALT/AST

Question 31

Biliary stricture diagnosis

Answer 31

ultrasound or CT showing dilated ducts. MRCP or ERCP for confirmation. Biopsy to differentiate benign vs malignant

Question 32

Biliary stricture management

Answer 32

ERCP with dilation or stenting. Biopsy to rule out malignancy. Surgery if refractory or malignant

Question 33

Primary sclerosing cholangitis (PSC)

Answer 33

an idiopathic, intra- and extrahepatic inflammatory disorder causing numerous Benign biliary strictures throughout the biliary tree. association with IBD (UC > crohns)

Question 34

Primary sclerosing cholangitis (PSC) symptoms and labs

Answer 34

RUQ pain, jaundice, fevers all due to cirrhosis of liver. Alk phos/GGT > AST/ALT. Bilirubin rises late.

Question 35

Primary sclerosing cholangitis (PSC) therapy

Answer 35

none effective except liver transplant. ERCP with stent if jaundiced.

Question 36

What is sphincter of Oddi dysfunction

Answer 36

motility disorder- intermittent.

Question 37

sphincter of Oddi dysfunction presentation and diagnosis

Answer 37

–Recurrent RUQ pain. ALT/AST/Alk phos elevations. Dilated bile duct on US. ERCP with sphincter of Oddi manometry

Question 38

Sphincter of Oddi dysfunction treatment

Answer 38

biliary sphincterotomy