Gallstones and Biliary Disease

Question 1

What are gallstones?

Answer 1

Hard stone formations in the gallbladder.

Question 2

What are the classic risk factors for gallstones?

Answer 2

Fair, fat, fertile, female, forty.

Question 3

What conditions increase gallstone risk?

Answer 3

Age, family history, Crohn’s disease, diabetes, gallbladder dysmotility, fasting, TPN.

Question 4

What are cholesterol gallstones made of?

Answer 4

Mainly cholesterol due to bile stasis or excess cholesterol.

Question 5

What causes pigment gallstones?

Answer 5

Excess bilirubin.

Question 6

What type are most gallstones?

Answer 6

Mixed (80%).

Question 7

Are most gallstones symptomatic or asymptomatic?

Answer 7

Asymptomatic.

Question 8

What are two common acute presentations of gallstones?

Answer 8

Biliary colic and acute cholecystitis.

Question 9

What causes acute cholecystitis?

Answer 9

Obstruction of the cystic duct by a gallstone.

Question 10

What is a positive Murphy’s sign?

Answer 10

Pain on inspiration when pressing in the RUQ.

Question 11

What imaging is used for acute cholecystitis?

Answer 11

USS (first-line), MRCP/ERCP for clarification.

Question 12

What are the key blood test findings in acute cholecystitis?

Answer 12

Raised ALP > ALT/AST, bilirubin, CRP, FBC.

Question 13

What is the initial management of acute cholecystitis?

Answer 13

IV antibiotics, fluids, NBM.

Question 14

What is definitive treatment for cholecystitis?

Answer 14

Cholecystectomy.

Question 15

What causes biliary colic?

Answer 15

Gallstone temporarily blocking the gallbladder neck.

Question 16

Is inflammation present in biliary colic?

Answer 16

No.

Question 17

What are the symptoms of biliary colic?

Answer 17

RUQ pain after eating, radiates to back/shoulder, nausea.

Question 18

How is biliary colic treated?

Answer 18

Painkillers, low-fat diet, cholecystectomy if recurrent.

Question 19

What is cholestasis?

Answer 19

Decreased bile flow due to secretion or obstruction issues.

Question 20

What causes obstructive cholestasis?

Answer 20

Gallstone in CBD, bile duct strictures, or malignancy.

Question 21

What causes metabolic cholestasis?

Answer 21

Genetic or drug-induced bile formation disturbances.

Question 22

What are the symptoms of cholestasis?

Answer 22

Jaundice, RUQ pain, fat malabsorption.

Question 23

What imaging confirms cholestasis?

Answer 23

USS, MRCP, or ERCP.

Question 24

How is gallstone-induced cholestasis treated?

Answer 24

ERCP for stone removal or CBD surgical exploration.

Question 25

What is gallstone ileus?

Answer 25

Small bowel obstruction from gallstone via gallbladder-duodenum fistula.

Question 26

How is gallstone ileus diagnosed?

Answer 26

AXR for obstruction, CT for confirmation.

Question 27

How is gallstone ileus treated?

Answer 27

Urgent laparotomy, interval cholecystectomy.

Question 28

What is cholangiocarcinoma?

Answer 28

Cancer of the bile ducts.

Question 29

What condition increases risk of cholangiocarcinoma?

Answer 29

Primary Sclerosing Cholangitis (PSC).

Question 30

What are symptoms of cholangiocarcinoma?

Answer 30

Jaundice, weight loss, anorexia, lethargy.

Question 31

How is cholangiocarcinoma treated?

Answer 31

Surgery (resection), palliative stenting.

Question 32

What is PSC?

Answer 32

Autoimmune fibrosis and destruction of bile ducts.

Question 33

Which IBD is associated with PSC?

Answer 33

Ulcerative colitis.

Question 34

What is the median age for PSC diagnosis?

Answer 34

35 years old.

Question 35

What imaging shows PSC?

Answer 35

MRCP – beaded strictures.

Question 36

How is PSC managed?

Answer 36

Balloon dilation, stenting, monitor for cancer.

Question 37

What is Primary Biliary Cholangitis (PBC)?

Answer 37

Chronic autoimmune destruction of interlobular bile ducts.

Question 38

Who is most commonly affected by PBC?

Answer 38

Women (9x more common).

Question 39

What is the hallmark antibody in PBC?

Answer 39

Anti-mitochondrial antibodies (AMA) M2 subtype.

Question 40

What are symptoms of PBC?

Answer 40

Fatigue, pruritus, jaundice, RUQ pain, xanthelasmas.

Question 41

What are complications of PBC?

Answer 41

Cirrhosis, osteoporosis, hepatocellular carcinoma.

Question 42

What is first-line treatment for PBC?

Answer 42

Ursodeoxycholic acid.

Question 43

What is used for pruritus in PBC?

Answer 43

Cholestyramine.

Question 44

When is liver transplant considered in PBC?

Answer 44

If bilirubin > 100.

Question 45

What does a cholestatic LFT pattern indicate?

Answer 45

Biliary obstruction or disease – ALP > ALT/AST.

Question 46

What liver enzyme is typically most raised in biliary obstruction?

Answer 46

Alkaline phosphatase (ALP).

Question 47

What does raised GGT support when ALP is also raised?

Answer 47

Hepatobiliary origin of the raised ALP.

Question 48

What LFT pattern is typically seen in hepatocellular damage (e.g. hepatitis)?

Answer 48

ALT and AST are higher than ALP.

Question 49

What does raised bilirubin suggest in biliary disease?

Answer 49

Obstruction of bile flow or impaired excretion.

Question 50

What is the significance of raised CRP and WCC in gallbladder disease?

Answer 50

Indicates inflammation or infection (e.g. acute cholecystitis).

Question 51

Why might albumin be low in chronic liver disease?

Answer 51

Reduced hepatic synthetic function.

Question 52

What does elevated conjugated (direct) bilirubin suggest?

Answer 52

Post-hepatic (obstructive) jaundice.

Question 53

What is the typical LFT finding in Primary Sclerosing Cholangitis (PSC)?

Answer 53

Cholestatic – raised ALP, GGT, and bilirubin.

Question 54

What is the typical LFT finding in Primary Biliary Cholangitis (PBC)?

Answer 54

Raised ALP, with normal or mildly raised ALT/AST