gallstones

Question 1

who is more likely to get men or women

Answer 1

women

Question 2

what are the 2 types

Answer 2

• cholesterol (more common)

- pigment

Question 3

what are pigment stones composed of

Answer 3

calcium bilirubinate

Question 4

what is most common type of stone

Answer 4

cholesterol gallstone

Question 5

what is cholesterol stone formation due to

Answer 5

cholesterol crystallisation from gall bladder bile

Question 6

what is cholesterol crystallisation dependent on

Answer 6

• cholesterol supersaturation of bile
• crystallisation promoting factors in bile
• motility of gall bladder

Question 7

where is most cholesterol derived from

Answer 7

hepatic uptake form dietary sources

Question 8

what is the rate limiting step of cholesterol synthesis

Answer 8

HMG-CoA reductase

Question 9

when does the cholesterol crystallise into stones

Answer 9

when the bile is supersaturated with cholesterol

Question 10

what is a highly selective intestinal cholesterol absorption inhibitor

Answer 10

ezetimibe

Question 11

how do statins work

Answer 11

competitive inhibition of HMG-CoA reductase

Question 12

what does leptin do

Answer 12

increase cholesterol secretion into bile

Question 13

what does gall bladder stasis lead to

Answer 13

cholesterol crystallisation mediated by hyper secretion of mucin

Question 14

risk factors fo cholesterol gallstones

Answer 14

• increasing age
• female
• family history
• rapid weight loss
• diet
• drugs (contraceptive pill)
• cirrhosis
• diabetes

Question 15

what are the 2 types of pigment stones

Answer 15

• brown

- black

Question 16

what are black pigment stones composed of

Answer 16

calcium bilirubinate

Question 17

what do black pigment stones look like on cross section

Answer 17

glass-like

Question 18

what are black stones associated with

Answer 18

haemolytic anaemias e.g. sickle cell disease

• malaria
• hepatic cirrhosis
• foot trauma

Question 19

what disease causes an increased prevalence of black pigment gallstones

Answer 19

Gilbert syndrome

Question 20

what are brown stones composed of

Answer 20

calcium salts of fatty acids

Question 21

what causes brown stones

Answer 21

bile stasis
or
biliary infection

Question 22

what is biliary colic

Answer 22

pain associated with temporary obstruction of the cystic or common bile duct by stone that has migrated from the gall bladder

Question 23

symptoms

Answer 23

• abdominal pain that can radiate to right shoulder
• nausea
• vomiting
• fever
• rigors

Question 24

what is the most useful investigation

Answer 24

ultrasound

Question 25

differential diagnosis

Answer 25

• IBS
• carcinoma of the right colon
• peptic ulcer
• renal colic
• pancreatitis

Question 26

what is the treatment of choice

Answer 26

cholecystectomy

Question 27

when is cholecystectomy done

Answer 27

when symptoms are present

Question 28

treatment of acute cholecystitis

Answer 28

• IV fluids
• opiate analgesia
• IV antibiotics

Question 29

what bacteria are associated with cholecystitis

Answer 29

• e.coli
• klebsiella
• enterococcus
• pseudomonas

Question 30

complications of cholecystectomy

Answer 30

• biliary leak

- injury to bile duct

Question 31

what is another method to treat cholesterol stones

Answer 31

solubilisation by increasing the bile salt content of bile

Question 32

how is stone dissolution done

Answer 32

orally with urseodeoxycholic acid

Question 33

symptoms of common bile duct stones

Answer 33

• biliary colic
• fever
• jaundice

Question 34

what is bilirubin levels of gallstones

Answer 34

raised bilirubin