General Surgery/GIT / Gallbladder Disease

Question 1

Calcium gallstones are the most common type. True or false?

Answer 1

False. 80% are cholesterol stones

Question 2

What are the risk factors for gallstones?

Answer 2

• Age >40 years
• female gender
• pregnancy
• oral contraceptive or estrogen replacement therapy
• obesity
• rapid weight loss
• Native American ethnicity
• family history of 1st degree relatives with gallstones
• “Fat, female, forty, and fertile”

Question 3

What is biliary colic?

Answer 3

Recurrent RUQ pain from the gallbladder contracting against a gallstone in the gallbladder outlet

Question 4

Where does the pain from biliary colic radiate?

Answer 4

To the back or right shoulder

Question 5

Can gallstones be seen on plain abdominal x-ray?

Answer 5

Only 10% of gallstones have enough calcium to be radiopaque

Question 6

In patients with a typical history of biliary colic but no evidence of gallstones on ultrasound, what other diagnostic tools can be used?

Answer 6

• CT of the abdomen
• HIDA scan
• bile microscopy
• endoscopic ultrasound

Question 7

How should patients with biliary colic and gallstones on ultrasound be treated?

Answer 7

• Pain control with meperidine or NSAIDs
• elective cholecystectomy

Question 8

Why is meperidine preferred over morphine in patients with biliary symptoms?

Answer 8

It causes theoretical decreased Sphincter of Oddi spasm.

Question 9

Is surgery indicated for the asymptomatic patient with incidental gallstones on ultrasound?

Answer 9

No

Question 10

What is the implication of finding a calcified gallbladder (porcelain gallbladder) on imaging?

Answer 10

• Increased risk of malignancy

Question 11

What are the complications of gallstones?

Answer 11

• Acute cholecystitis
• ascending cholangitis
• acute biliary pancreatitis
• gallstone ileus
• gallbladder cancer

Question 12

What sign is positive when a patient has severe pain and inspiratory arrest with palpation in the area of the gallbladder?

Answer 12

Murphy sign

Question 13

What are the key lab findings of acute cholecystitis?

Answer 13

Leukocytosis with a left shift

Question 14

What ultrasound findings support a diagnosis of acute cholecystitis?

Answer 14

• The presence of gallstones with gallbladder wall thickening
• pericholecystic fluid or
• a sonographic Murphy sign

Question 15

How should acute cholecystitis be treated?

Answer 15

• IV fluids
• NPO status
• pain control with opioids or ketorolac
• empiric antibiotics
• cholecystectomy

Question 16

What is the name for cholecystitis in the absence of gallstones (5%-10%, or cases of acute cholecystitis)?

Answer 16

Acalculous cholecystitis

Question 17

What groups of patients are especially at risk for acalculous cholecystitis?

Answer 17

• Critically ill patients or
• following major surgery or trauma
• patients on total parenteral nutrition (TPN)

Question 18

What is the name for the triad of fever, jaundice, and RUQ pain found in ascending cholangitis?

Answer 18

Charcot triad

Question 19

What lab findings are consistent with ascending cholangitis?

Answer 19

• Leukocytosis with left shift
• elevated alkaline phosphatase, gammaglutamyl transpeptidase (GGT), and conjugated bilirubin

Question 20

Reynold pentad of altered mental status, hypotension, fever, jaundice, and RUQ pain is found in what condition?

Answer 20

Supparative cholangitis

Question 21

What percentage of patients with gallstone disease develop pancreatitis?

Answer 21

5%

Question 22

What percentage of acute pancreatitis is caused by gallstones?

Answer 22

33%

Question 23

In what patient population is gallstone ileus most common?

Answer 23

Elderly patients