High-Yield Concepts in Gallbladder and Biliary Diseases (Gastrointestinal Diseases)

Question 1

2 major type of Gallstones

Answer 1

Cholesterol stones (>80%)
Pigment stones (

Question 2

Most important mechanism in the formation of lithogenic bile

Answer 2

Increased biliary secretion of cholesterol

Question 3

2 key changes during pregnancy that contribute to a cholelithogenic state

Answer 3

∙ A marked increase in cholesterol saturation of bile during the 3rd trimester
∙ Sluggish gallbladder contraction in response to a standard meal → impaired gallbladder emptying

Question 4

Most frequently isolated organisms in gallbladder bile

Answer 4

Escherichia coli, Klebsiella spp., Streptococcus spp., Clostridium spp.

Question 5

Most frequently cultured bacteria in Emphysematous Cholecystitis

Answer 5

Anaerobes, such as Clostridium welchii or Clostridium perfringens
Aerobes, such as E.coli

Question 6

Mostfrequent demographic for Emphysematous Cholecystitis

Answer 6

Elderly men and diabetics

Question 7

Radiographic diagnosis of Emphysematous Cholecystitis

Answer 7

Gas within the gallbladder lumen on plain abdominal film, dissecting within the gallbladder wall to form a gaseous ring

Question 8

Murphy’s Sign

Answer 8

Deep inspiration or cough during subcostal palpation of the RUQ produces increased pain and inspiratory arrst, suggestive of acute cholecystitis or cholangitis

Question 9

Mirizzi’s Syndrome

Answer 9

Gallstones becomes impacted in the cystic duct or neck of the gallbladder causing compression of the CBD, resulting in obstruction and jaundice

Question 10

Courvoisier’s Law

Answer 10

Presence of a palpably enlarged gallbladder suggests that the biliary obstruction is secondary to an underlying malignancy rather than to calculous disease

Question 11

Sonographic criteria for identifying gallstones

Answer 11

Acoustic “shadowing” of opacities that are within the gallbladder lumen
Change with the patient’s position (by gravity)

Question 12

Most common site of fistula formation in Cholecystitis

Answer 12

Fistula in the duodenum

Question 13

Usual site of obstruction in gallstone Ileus

Answer 13

Ileocecal Valve

Question 14

Porcelain Gallbladder

Answer 14

Calcium salt deposition within the wall of a chronically inflamed gallbladder; associated with gallbladder carcinoma, so cholecystectomy is advised

Question 15

Usual analgesics for Acute Cholecystitis

Answer 15

Meperidine or NSAIDs (produce less spasm of sphincter of Oddi than morphine)

Question 16

Gold standard for treating symptomatic Cholelithiasis

Answer 16

Laparoscopic cholecystectomy

Question 17

Treatment of choice for Acute Cholecystitis

Answer 17

Early cholecystectomy (within 72 hours)

Question 18

Delayed surgical intervention in Cholecystitis

Answer 18

Overall medical condition imposes an unacceptable risk for early surgery
Diagnosis of acute cholecystitis in doubt

Question 19

Most common cause of persistent Postcholecystectomy Symptoms

Answer 19

Overlooked symptomatic nonbiliary disorder (reflux esophagitis, peptic ulceration, pancreatitis, or most often, irritable bowel syndrome)

Question 20

Most common biliary anomalies in infancy

Answer 20

Biliary atresia and hypoplasia

Question 21

Caroli’s Disease

Answer 21

Congenital biliary ectasia involving the major intrahepatic radicles

Question 22

Most common type of Cholangitis

Answer 22

Nonsuppurative acute cholangitis (vs. suppurative)

Question 23

Procedure of choice for Cholangitis

Answer 23

ERCP with endoscopic sphincterotomy (both diagnostic and therapeutic)

Question 24

Most common associated entity in patients with Nonalcoholic Acute Pancreatitis

Answer 24

Biliary tract disease

Question 25

Risk factors for concomitant CBD stones in patients iwth Gallstones

Answer 25

History of jaundice or pancreatitis
Abnormal tests of liver function
Ultrasonographic or MRCP evidence of a dilated CBD

Question 26

Preferred approach if CBD stones are suspected prior to Laparoscopic Cholecystectomy

Answer 26

Preoperative ERCP with endoscopic papillotomy and stone extraction

Question 27

Treatment of choice for Choledocholithiasis

Answer 27

Endoscopic biliary sphincterotomy (EBS)

Question 28

Most common cause of benign strictures of the extrahepatic bile ducts

Answer 28

Surgical trauma

Question 29

Most common cause of extrinsic bile duct compression

Answer 29

Carcinoma of the pancreatic head

Question 30

Organisms most commonly involved in Hepatobiliary Parasitism

Answer 30

Trematodes or flukes, including Clonorchis sinensis, Opisthorchis viverrini or O. felineus, Fasciola hepatica

Question 31

Earliest lesion in Primary Biliary Cirrhosis (PBC)

Answer 31

Chronic nonsuppurative destructive cholangitis

Question 32

Antibodies associated with PBC

Answer 32

Antimitochondrial antibodies (AMA)

Question 33

Main symptoms of PBC

Answer 33

fatigue and pruritus

Question 34

Only approved treatment for PBC

Answer 34

Ursodeoxycholic acid (UDCA) can slow the rate of progression of disease (but cannot reverse or cure)

Question 35

Treatment of choice for decompensated cirrhosis due to PBC

Answer 35

Liver transplantation

Question 36

Imaging technique of choice for the initial evaluation of Primary Sclerosing Cholangitis (PSC)

Answer 36

MRCP (but ERCP is the traditional gold standard diagnostic test)

Question 37

Typical cholangiographic findings in PSC

Answer 37

Multifocal stricturing and beading involving both the intra and extrahepatic biliary tree

Question 38

Ultimate treatment for PSC

Answer 38

Liver transplant

Question 39

Dreaded complication of PSC

Answer 39

Development of cholangiocarcinoma