Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Acute Surgery > Gallstones and Gallbladder Pathology > Flashcards

Gallstones and Gallbladder Pathology Flashcards

1
Q

What is the medical term for gallstones?

A

Cholelithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the medical term for the presence of gallstones in the common bile duct?

A

Choledocholithiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the medical term for inflammation of the gallbladder?

A

Cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The vast majority of gallstones are composed of…?

A

Cholesterol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the five main risk factors for gallstone formation?

A 
The 5 Fs:
Female
Forty
Fertile
Fat
Fair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What colour are cholesterol gallstones?

A

Yellow (i.e. fat coloured)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cholesterol stones show up on x-ray. T/F?

A

False

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cholesterol gallstones can form when there is too much cholesterol present in bile. What risk factors can potentially increase cholesterol levels?

A

Obesity - increased fat = increased cholesterol
Female sex, pregnancy and oral contraceptive pill act to increase the action fo HMG reductase (the enzyme which produces cholesterol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cholesterol gallstones can form when there are not enough bile salts / phospholipids present in the bile. What factors can predispose to this?

A

Anything which affects the terminal ileum and thus affects the reabsorption of bile acids such as Chron’s disease or ill resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Gallbladder stasis can increase the risk of gallstone formation. What factors may cause gallbladder stasis?

A

Pregnancy (due to increased progesterone which decreases gallbladder activity)
Rapid weight loss
Medications such as octreotide
High spinal cord injuries
Total parenteral nutrition (decreases production of cholecystokinin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What colour are bilirubin gallstones?

A

Black

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why can bilirubin gallstones be seen on x-ray whilst cholesterol stones cannot?

A

Because bilirubin combines with calcium to form stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the main risk factor for the formation of bilirubin gallstones and in which conditions does the risk factor exist?

A

Main risk factor: extravascular haemolysis

Conditions which cause this:
Sickle cell disease
Beta thalassaemia
Hereditary spherocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Most gallstones are asymptomatic. T/F?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Asymptomatic gallstones do not require intervention. T/F?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the term for uncomplicated symptomatic cholelithiasis?

A

Biliary colic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the cause of biliary colic?

A

a gallstone becoming lodged in the cystic duct causing pain when the gallbladder contracts after meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe the presentation of pain in biliary colic?

A

Steady, constant dull RUQ / epigastric pain which is worst after meals when the gallbladder is contracting. Pain may radiate around both costal margins and into the back. Generally lasts for a few hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What symptoms may be associated with pain in biliary colic?

A

Nausea and (less commonly) vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What findings would you expect to find on examination in biliary colic?

A

RUQ/epigastric tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the key diagnostic test for biliary colic?

A

Ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the expected results on ultrasound in biliary colic?

A

Stones present in the gallbladder in the absence of signs of gallbladder inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If ultrasound results are negative in suspected biliary colic, what further imaging test may be used?

A

Abdominal CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is biliary colic treated?

A

Analgesia and elective cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

The vast majority of cases of acute cholecystitis are caused by gallstones. T/F?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Describe the pathophysiology of acute cholecystitis?

A

When a gallstone becomes stuck in the cystic duct. bile becomes trapped within the gallbladder resulting in irritation of the mucosa of the gallbladder leading to inflammation (mediated by prostaglandins), distension and pressure build-up. This can result in secondary bacterial infection leading to necrosis and perforation in some cases.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What percentage of cases of acute cholecystitis occur in the abscess of gallstones?

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the most likely cause of calculus acute cholecystitis?

A

Bile inspissation

Bile stasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the risk factors for calculus acute cholecystitis?

A

Sepsis, immunosuppression, diabetes mellitus, mechanical ventilation, CMV infection, total parenteral nutrition, major trauma and burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Why is acalculous acute cholecystitis often hard to diagnose?

A

Clinical manifestations may be very subtle in this conditions as most of these patients will be sedated or intubated
the only clue to this diagnosis may be an increased ALP

31
Q

Describe the presentation fo pain in acute cholecystitis?

A

Severe RUQ / epigastric pain which may radiate around the costal margins, into the back or into the right shoulder
Patients will prefer to lie still and take shallow breaths as this is a form of local peritonitis

32
Q

What symptoms may be associated with pain in acute cholecystitis?

A

Nausea and vomiting

33
Q

What abnormal findings of observations might you expect to see in a patient with acute cholecystitis?

A

Fever

Tachycardia

34
Q

Boas sign is often present in acute cholecystitis. What is Boas’ sign?

A

Radiation of pain into the right scapula / shoulder

35
Q

Murphy’s sign is often present in acute cholecystitis. What is Murphy’s sign?

A

Murphy’s sign is positive when pain can be elicited by deeply palpating the costal margin of the RUQ of the abdomen and asking the patient to take a deep breath in which results in the diaphragm pushing down and driving the gallbladder onto the examining hand

36
Q

Can jaundice occur in acute cholecystitis?

A

Yes though this only occurs in ~10% of cases

37
Q

What results would you expect to see on blood results in acute cholecystitis?

A

Raised inflammatory markers - CRP/ESR
Raised WCC
In some cases may also be signs of obstructive jaundice on LFTs

38
Q

In cases of suspected acute cholecystitis, what blood tests are important to order to rule out acute pancreatitis as a differential?

A

Serum lipase and amylase

39
Q

Ultrasound is the key diagnostic test for acute cholecystitis. what results would you expect to see on this test?

A

Presence of gallstones

Signs of gallbladder inflammation - pericholecystic fluid, distended gallbladder, thickened gallbladder wall

40
Q

List some possible differentials of acute cholecystitis?

A 
Acute cholangitis
Chronic cholecystitis
Peptic ulcer disease
Acute pancreatitis
Sickle cell crises
Appendicitis
Right lower lobe pneumonia
Acute coronary syndrome
GORD
41
Q

Acute cholecystitis can be managed conservatively or with acute cholecystectomy. T/F?

A

True

42
Q

Why might a cholangiogram be performed at the same time as cholecystectomy?

A

To assess the anatomy, flow and possible presence of stones in the common bile duct so that these could be removed in the same procedure if necessary

43
Q

What examination finding would be present if acute cholecystitis progressed to gallbladder perforation?

A

Rebound tenderness

44
Q

What are some of the potential complications of acute cholecystitis?

A 
Peritonitis
Suppurative cholecystitis
Bile duct injury due to surgery 
Gallstone ileus
Cholecysteoenteric fistulas
45
Q

Describe the pathophysiology of gallstone ileus?

A

Repeated bouts of acute cholecystitis might cause the gallbladder wall to adhere to a nearby structure (commonly duodenum). Eventually the gallbladder wall can erode, forming a fistula through which gallstones can pass into the intestines. Gallstones will move through the intestine by peristalsis and most often impact around the ileocaecal valve as this is the narrowest part of the tract

46
Q

What is the typical presentation of gallstone ileus?

A

Signs of small bowel obstruction - abdominal distension, nausea, vomiting
On a background of recurrent RUQ pain consistent with chronic cholecystitis

47
Q

Riggler’s triad describes the signs of gallstone ileus which can be seen on AXR. What three signs comprise this triad?

A

Signs of distal small bowel obstruction
Gas present in the biliary tree. (pneumobilia)
Presence of gallstone in RLQ of abdomen

48
Q

Gallstone ileus often isn’t diagnosed until surgery. T/F?

A

True

49
Q

How is gallstone ileus treated?

A

Enterotomy and stone extraction with interval cholecystectomy 4-6 weeks later

50
Q

What is the presentation chronic cholelithiasis?

A

Long standing history of vague RUQ pain after meals

51
Q

What is the name of the fibrosis and dystrophic calcification of the gallbladder which can be associated with chronic inflammation and is most commonly picked up incidentally on imaging?

A

Porcelain gallbladder

52
Q

Why is a porcelain gallbladder significant?

A

Results in an increased risk of developing adenocarcinoma of the gallbladder

53
Q

How is a porcelain gallbladder treated?

A

Cholecystectomy

54
Q

Adenocarcinoma of the gallbladder has good survival rates. T/F?

A

False - it is often not found until late stages when metastasis has already occurred so is associated with a poor survival rate

55
Q

Describe the presentation of Choledocholithiasis?

A

RUQ pain typical of biliary colic

Accompanied by fever and (obstructive) jaundice

56
Q

On LFTs there will be a pattern of obstructive jaundice in Choledocholithiasis. What is meant by ‘obstructive pattern’?

A

Raised bilirubin indicating jaundice alongside:
Markedly raised ALP and GGT
Raised AST and ALT

57
Q

Ultrasound is not particularly good for picking up the presence of stones in the gallbladder, however it is very sensitive for which sign of Choledocholithiasis?

A

Dilatation of the common bile duct

58
Q

In suspected Choledocholithiasis, if stones cannot be seen in the common bile duct on ultrasound, what further imaging tests may be used?

A

Abdominal CT

MRCP

59
Q

How is Choledocholithiasis managed?

A

ERCP with biliary sphincterotomy and stone extraction

Followed by elective cholecystectomy

60
Q

What are the potential complications of Choledocholithiasis?

A

Ascending Cholangitis
Acute biliary pancreatitis
Hepatic abscess

61
Q

What are the potential complications of the management of Choledocholithiasis?

A

ERCP-associated pancreatitis
Iatrogenic bile duct injuries
Post-sphincterotomy bleeding

62
Q

What is acute/ascending cholangitis?

A

Infection of the biliary tree, most commonly associated with obstruction

63
Q

What is the most common aetiology of ascending cholangitis?

A

Obstruction of the common bile duct with gallstones

64
Q

Besides gallstones, what aetiologies can result in obstruction causing acute cholangitis?

A

Iatrogenic biliary duct injury

Chronic pancreatitis or biliary injury due to systemic chemotherapy causing a benign stricture

65
Q

What hepatic pathology can (relatively commonly) cause ascending cholangitis?

A

Sclerosing cholangitis (primary or secondary)

66
Q

Describe the pathophysiology of ascending cholangitis?

A

Obstruction of the bile duct allows bacterial seeding of the biliary tree (possibly via the portal vein) which results in bacterial contamination
Sludge forms in the ducts, providing a growth medium for the bacteria
As the obstruction progresses, bile duct pressure increases, forming a pressure gradient which promoted extravasation of the bacteria into the bloodstream and can result in sepsis

67
Q

Ascending cholangitis typically presents with Charcot’s triad. Describe this triad.

A

Fever (riggers)
RUQ pain
Obstructive jaundice

68
Q

Ascending jaundice with sepsis can present with Reynold’s pentad. What signs/symptoms make up this pentad?

A 
Fever (riggers)
RUQ pain
Obstructive jaundice
Mental status changes / confusion
Hypotension
69
Q

What are the risk factors for ascending cholangitis which should be considered when taking a patient history?

A 
Age >50 years
PMHx of gallstones 
Prior ERCP
Prior surgical/radiological biliary tree interventions
PMHx of HIV
70
Q

What imaging tests are typically used in ascending cholangitis?

A

Transabdominal ultrasound - looking for evidence of Choledocholithiasis
Abdominal CT with IV contrast if ultrasound is negative

71
Q

What is involved in the initial management of ascending cholangitis?

A 
IV fluids 
Broad spectrum IV antibiotics
Correction of any electrolyte imbalances
Correction of any coagulation abnormalities
Analgesia
72
Q

Biliary decompression is required in ascending cholangitis. In what time frame would this be performed?

A

within 12-24 hours for patients with possible signs of sepsis
within 24-48 hours for patients who are stable with initial management

73
Q

What are the options for biliary decompression in ascending cholangitis?

A

ERCP +/- sphincterotomy and stunting
Percutaneous hepatic cholangiography
Endoscopic lithotripsy
Surgical decompression as last resort

74
Q

Patients with ascending cholangitis will require subsequent cholecystectomy. T/F?

A

True - if it was caused by gallstone pathology

Acute Surgery (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions