GI - Pathology (Gallbladder)

Question 1

What is another name for gallstones? What are the 4 major causes of this?

Answer 1

Gallstones (cholelithiasis); (1) Increased cholesterol and/or (2) bilirubin, (3) Decreased bile salts, and (4) gallbladder stasis all cause stones

Question 2

What are 2 types of gallstones? Which constitutes the greater percentage of gallstones, and what is that percentage?

Answer 2

(1) Cholesterol stones - 80% of stones (2) Pigment stones

Question 3

What are the appearance(s) of cholesterol versus pigment stones?

Answer 3

Cholesterol stones (radiolucent with 10-20% opaque due to calcifications); Pigment stones (black = radiopaque, hemolysis; brown = radiolucent, infection)

Question 4

What are 9 associations with cholesterol gallstones?

Answer 4

Associated with (1) obesity, (2) Crohn disease, (3) cystic fibrosis, (4) advanced age, (5) clofibrate, (6) estrogen therapy, (7) multiparity, (8) rapid weight loss, and (9) Native American origin

Question 5

What are 4 conditions in which pigment gallstones are seen?

Answer 5

Seen in patients with (1) chronic hemolysis, (2) alcoholic cirrhosis, (3) advanced age, and (4) biliary infection

Question 6

What are 4 risk factors for gallstones?

Answer 6

Risk factors: (1) Female (2) Fat (3) Fertile (pregnant) (4) Forty; Think: “4 F’s”

Question 7

What is the triad of cholangitis? What is it called?

Answer 7

Charcot triad of cholangitis: (1) Jaundice (2) Fever (3) RUQ pain

Question 8

What is the most common complication of gallstones (cholelithiasis)? What are 5 other complications?

Answer 8

Most often causes cholecystitis; Also ascending cholangitis, acute pancreatitis, bile stasis. Can also lead to biliary colic (and)… Gallstone ileus.

Question 9

Describe the pathophysiology of biliary colic as a complication of gallstones.

Answer 9

Can also lead to biliary colic - neurohormonal activation (e.g., by CCK after a fatty meal) triggers contraction of the gallbladder, forcing a stone into the cystic duct.

Question 10

How may biliary colic peculiarly present? Give an example of a patient population in which this may occur.

Answer 10

May present without pain (e.g., in diabetics)

Question 11

What is gallstone ileus, and what causes it, particularly in the context of gallstones? What is a sign of its cause?

Answer 11

Gallstones can cause fistula between gallbladder and small intestine, leading to air in biliary tree. Gallstone may obstruct ileocecal valve => gallstone ileus.

Question 12

How are gallstones (cholelithiasis) diagnosed and treated, and in what context?

Answer 12

Diagnosed with ultrasound (may show distended gallbldadder containing gallstone). Treat with cholecystectomy if symptomatic.

Question 13

What is cholecystitis?

Answer 13

Acute or chronic inflammation of gallbladder

Question 14

What usually causes cholecystitis (be specific)? What are 2 other causes?

Answer 14

Usually form cholelithiasis (gallstones); most commonly blocking cystic duct => secondary infection; Rarely ischemia or primary infection (CMV)

Question 15

What is Murphy sign, and to which clinical condition does it correlate?

Answer 15

Murphy sign (+) - inspiratory arrest on RUQ palpation due to pain; Cholecystitis

Question 16

In what context within cholecystitis is ALP used as a significant lab finding, and how so?

Answer 16

Increased ALP if bile duct becomes involved (e.g., ascending cholangitis)

Question 17

How is cholecystitis diagnosed?

Answer 17

Diagnose with ultrasound or HIDA

Question 18

What is a porcelain gallbladder, and what causes it? How does it usually present?

Answer 18

Calcified gallbladder (seen on X-ray of abdomen) due to chronic cholecystitis; usually found incidentally on imaging

Question 19

What is the treatment for porcelain gallbladder, and why?

Answer 19

Treatment: prophylactic cholecystectomy due to high rates of gallbladder carcinoma