Gallstones and Biliary Tract Disease

Question 1

Three common symptoms in choledochal cysts/biliary cysts

Answer 1

Abdominal pain

Palpable mass

Jaundice

Question 2

Choledochal cysts/biliary cysts are associated with an increased risk of this cancer

Answer 2

Cholangiocarcinoma

Question 3

Two pathophysiological factors that increase risk of gallstones

Answer 3

High cholesterol in bile

Gallbladder stasis

Question 4

Murphy’s sign suggests acute cholecystitis. Is it more painful with inspiration or expiration?

Answer 4

Inspiration

Question 5

Best test and treatment for choledocholithiasis

Answer 5

ERCP

Question 6

90-95% of acute cholecystitis is caused by …

Answer 6

Gallstones

Question 7

The common bile and pancreatic duct join and shoot into the intestines here

Answer 7

Sphincter of Oddi

Question 8

Cholecystitis is more likely when the pain lasts longer than …

Answer 8

Six hours

Question 9

Treatment for acute cholecystitis

Answer 9

NPO

Prep for surgery, should be done within 96 hours of symptom onset

Question 10

“Porcelain gallbladder” may be seen in this condition

Answer 10

Chronic cholecystitis

Question 11

Describe the three components of Charcot’s Triad and in which conditions it might be seen

Answer 11

Fever + Jaundice + RUQ pain

Seen in cholangitis conditions (inflammation of bile ducts)
- choledocholithiasis
- primary sclerosing cholangitis
- pyogenic cholangitis

Question 12

Most common symptom in cholecystitis and cholecystolithiasis

Answer 12

Biliary colic (functional spasm of cystic duct)

Question 13

Stones in the gallbladder are called (blank) and stones in the common bile duct are called (blank)

Answer 13

Stones in gallbladder = Cholelithiasis

Stones in common bile duct = Choledocholithiasis

Question 14

Patients who are most likely to have primary sclerosing cholangitis

Answer 14

Men aged 20-50

Question 15

This condition is an inflammatory, progressive fibrosis of intra/extrahepatic bile ducts with a median survival of 10-12 years (if no transplant)

Answer 15

Primary sclerosing cholangitis

Question 16

Which two imaging types to use in acute cholecystitis?

Answer 16

Ultrasound (wall edema, stones, distension, swelling of gallbladder)

Cholescintigraphy aka HIDA scan (IV nuclear test to see if can get something in to gallbladder)
- no visible gallbladder suggests cystic duct obstruction

Question 17

Describe pyogenic cholangitis

Answer 17

Recurrent cholangitis caused by repeated bacterial infections of the biliary tree

Question 18

Most gallstones are made of …

Answer 18

Cholesterol

Question 19

Almost all patients with primary sclerosing cholangitis have this co-occuring GI condition

Answer 19

Ulcerative colitis

Question 20

Four risk factors for gallstones

Answer 20

Age (start to see after age 40, most after age 60)

Obesity (more cholesterol in body)

Native American

Females

Question 21

Describe the cause of choledocholithiasis

Answer 21

Stone in common duct, typically comes from gallbladder

Question 22

Sphincter of Oddi dysfunction can result from these processes

Answer 22

Any process that leads to scarring

(pancreatitis, gallstone passage, infection, cholecystectomy)

Question 23

Location of pain in cholecystitis and cholecystolithiasis

Answer 23

Pain radiates to back or right shoulder

Question 24

Diagnostic test of choice for chronic cholecystitis

Answer 24

Ultrasound

Question 25

Lab tests for acute cholecystitis will show elevated levels of these 3 things

Answer 25

Leukocytosis (12-15,000)

Serum bilirubin

ALP (sign of biliary tree obstruction)

(amylase may be elevated if common duct obstructed)

Question 26

Two main symptoms in primary sclerosing cholangitis

Answer 26

Pruritus and fatigue

(also pain and weight loss)

Question 27

Treatment for chronic cholecystitis

Answer 27

Elective cholecystectomy

Ursodiol can break up stones over course of years

Question 28

Best way to diagnose Sphincter of Oddi dysfunction

Answer 28

ERCP - may reveal dilated common duct

Question 29

Acute cholecystitis symptoms of nausea, vomiting, and/or RUQ pain are more likely to occur with …

Answer 29

Eating