Gallstones

Question 1

List risk factors for gallstones

Answer 1

Age >40
Female
Pregnancy
OCP/ estrogen therapy
obesity
rapid weight loss
Crohns disease
Hemolysis

Question 2

Hemolysis causes _______ gallstones

Answer 2

pigmented

Question 3

Jaundice due to hemolytic anemia causes what changes in bilirubin levels?

Answer 3

Greater increase in unconjugated than conjugated bilirubin

Question 4

Jaundice due to hepatitis causes what changes in bilirubin levels?

Answer 4

Similar increase in both conjugated and unconjugated bilirubin

Question 5

Jaundice due to biliary duct stone causes what changes in bilirubin levels?

Answer 5

Greater increase in conjugated than unconjugated bilirubin

Question 6

Bile is composed of:

Answer 6

Water, Bile acids, Phospholipids, Electrolytes, Cholesterol, Bilirubin

Question 7

List three key features of biliary stone formation

Answer 7

supersaturation
crystal nucleation
stasis/ hypomotility
= cholelithiasis

Question 8

List 6 conditions/ clinical manifestations of biliary stone formation

Answer 8

1) Symptomatic cholelithiasis
2) Acute cholecystitis
3) Chronic cholecystitis
4) Choledocholithiasis
5) Gallstone pancreatitis
6) Cholangitis

Question 9

What is the treatment for symptomatic cholelithiasis?

Answer 9

cholecystectomy

Question 10

How is acute cholecystitis diagnosed on MRI?

Answer 10

thickened gall bladder wall, pericholecystic fluid

Question 11

What is the treatment for acute cholecystitis?

Answer 11

cholecystectomy

Question 12

What are possible outcomes if cholecystectomy is not performed on a patient with acute cholecystitis?

Answer 12

perforation

gangrene

Question 13

Describe the presentation of chronic cholecystitis

Answer 13

post-prandial RUQ pain, nausea
normal LFTs/CBD
fibrotic/ thickened gallbladder wall due to chronic irritiation
invariably associated with cholelthiasis

Question 14

How is chronic cholecystitis treated

Answer 14

cholecystectomy

Question 15

It is important to recognize porcelain gallbaldder because of the significant risk of _______

Answer 15

gallbladder cancer

tx= cholecystectomy

Question 16

What is choledocholithiasis?

Answer 16

gallstones in duct, can occur even after cholecystectomy

Question 17

What is the treatment for choledocholithiasis?

Answer 17

ERCP with stone extraction, sphincterotomy

Question 18

What are possible complications of choledocholithiasis?

Answer 18

acute cholangitis

gallstone pancreatitis

Question 19

Describe the presentation of gallstone pancreatitis

Answer 19

severe constant epigastric pain radiating to back
elevated WBCs, elevated bilirubin/ ALKP/ ALT/AST/ amylase/ lipase
CT with peri-pancreatic inflammation, dilated bile ducts, cholelithiasis

Question 20

What is the treatment for gallstone pancreatitis?

Answer 20

IV fluids and medically stabilize

ERCP stone extraction

Question 21

List key symptoms that suggest acute cholangitis

Answer 21

RUQ pain, fever, jaundice, hypotension, mental status changes

Question 22

Describe the findings seen in acute cholangitis

Answer 22

Elevated WBCs, LFTs

MRCP shows common bile duct full of stones, obstruction of biliary tree, and purulent fluid filling biliary tree

Question 23

List bacteria commonly implicated in acute cholangitis

Answer 23

E coli, Klebsiella, Enterobacter species

Question 24

How is acute cholangitis managed?

Answer 24

Medical support including IV antibiotics, biliary drainage (via ERCP or PTC)