Gallstones and Billiary Tree: Mechanical Cholestasis

Question 1

What is cholestasis

Answer 1

Anything that interferes with billiary secretion

Question 2

Five components of Bile?

Answer 2

• Bile Acids- (solubilize cholesterol) must have for fat absorption
• Phospholipid- (solubilize cholesterol)
• IgA and IgM- Bacteriostasis
• Mucus- prevent bacterial adhesion
• Glutathione- Induces bile flow

Question 3

What are the two most important components of bile?

Answer 3

• Bile Acids
• Phospholipid

Both of these components are necessary for fat absorption

Question 4

Bile Acids and Phospholipids are important for what?

Answer 4

Solubilizing cholesterol

Question 5

Know stone types

Answer 5

ok

Question 6

Cholesterol metabolism slide

Answer 6

know it

Question 7

Cholesterol stones have what appearance

Answer 7

They are usually yellowish white and rarely seen on x-ray (radiolucent). This is the most common type of stone.

Question 8

Black stones

Answer 8

Hemolysis

Question 9

Brown stones

Answer 9

Infection

Question 10

Pigment stones (those that are black or brown are visible on x ray or not?

Answer 10

Visible (radioopaque)

Question 11

What are some conditions that are related to stone formation (cholesterol)

Answer 11

• Female
• Fat
• Forty
• Fertile (pregnant)

More expansive list is Crohn’s disease, obesity, Cystic Fibrosis, advanced age, estrogens, multiparity, rapid weight loss and advanvced age.

Question 12

What is cholecystitis?

Answer 12

Inflammation of the gallbladder usually due to a stone…

Question 13

When does cholecystitis become serious ?

Answer 13

When the common bile duct becomes involved…this can lead to ascending cholangitis.

So cholecystits occurs when a stone exists in the cystic duct leading off of the gallbladder. If there is an obstruction in the common bile duct, things get real because this can lead to ascending cholangitis

Question 14

MOST SIGNIFICANT IMPACT ON STONE FORMATION

Answer 14

High Cholesterol

Question 15

What is the major enzyme that is responsible for incorporating cholesterol into bile salts? This enzyme decreases with age

Answer 15

Cholesterol 7alpha hydroxylase

Question 16

Obesity impacts cholesterol metabolism how?

Answer 16

Enhances the conversion of acetate to cholesterol through increased HMG coA activity

Question 17

The only real way to get rid of free cholesterol is:

Answer 17

To secrete it in the bile

Question 18

Estrogens have what impact on cholesterol metabolism?

Answer 18

Increase the uptake of Serum lipoproteins into the liver. Bascially increase cholesterol uptake from serum

Question 19

Progesterones/ oral contraceptives

Answer 19

More free cholesterol due to decreased conversion to cholesterol ester stores

Question 20

Charcot’s triad of cholangitis?

Answer 20

Jaundice
Fever
Right Upper Quadrant pain (MUST HAVE PAIN)

Question 21

Bile acids are reabsorbed and enter into the enterohepatic circulation in which part of the small intestins

Answer 21

Terminal Illeum

Question 22

In patients with gallstones, gallbladder emptying is very slow (hypomotility). This is potentially related to ?

Answer 22

Increased mucin

Question 23

What is Biliary Colic?

Answer 23

Occurs when you have a stone that is blocking the cystic duct. Associated with pain, nausea, vomiting, but no fever, chills, or signs of gallbladder inflammation. The pain will disappear as soon as the stone either passes or moves back into the gallbladder

Question 24

What do you do for someone with Biliary colic?

Answer 24

Send them home and tell them they need to speak to someone about having their gallbladder removed

Question 25

Acute Cholecystits presentation>?

Answer 25

usually a woman over 40. She will present with abdominal pain that has been there for hours (unlike simple biliary colic). She will also have a fever and chills (unlike colic). WHite count may be high and the gallbladder walls will be inflammed because this stone has been stuck in the cystic duct for a while.

She needs to be admitted and probably sent to surgery

Question 26

Choledocholithiasis

Answer 26

This occurs when a gallstone has made it out of the cystic duct but gets trapped in the common bile duct. The pt will present with fever, chills, abdominal pain, and JAUNDICE.

Question 27

What is choledocolithiasis with cholangitis?

Answer 27

Cholangitis occurs when you get inflammation inside the bile ducts of the liver due to a stone blocking the common bile duct. This is very bad news and the mortality is extremely high

Question 28

What is biliary pancreatitis

Answer 28

occurs when a stone blocks the common bile duct below where the pancreatic duct comes in. Not only do you get choledocolithisasis, but you will get pancreatitis. Tests will show high pancreatic enzymes. Pt will have pian and persistent nausea and vomitting

Question 29

Emphysematous cholecystits

Answer 29

gallbladder full of gas