Natural History of Gallstones Flashcards
First Successful cholecystectomy was performed by ?
- Vesalius
- Carl Langenbuch
- Eric Muhe
- Fernelius
Ans B - Carl Langenbuch - performed the first cholecystectomy
Vesalius - first described gallstones.
Eric Muhe - performed the first laparoscopic cholecystectomy.
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What percentage of adult population is affected by gallstones?
A. 2-5%
B. 5-10%
C. 10-15%
D. 15-20%
Ans - 10-15% of the adult population is affected by gallstones.
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What is the mortality rate for gallstones disease ?
A. 0.1-0.5%
B. 0.5-1%
C. 1-2%
D. 2-5%
Ans - B
the mortality rate for gallstones disease is relatively low at 0.6%.
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Most common gallstones in western countries are ?
A. mixed stones
B. Brown pigmented stones
C. Cholesterol stones
D. Black Pigmented stones
Ans - C. Cholesterol stones are more common in western countries - >85%.
Brown pigmented stones are more common in Asia.
highest rates of gallstones are found in?
A. Native American Indian Women
B. Native American Indian Men
C. Mapuche indians of chile
D. Hispanics
Ans - A - native american indian women have rates of 67.1%.
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Highest rates of gallstones in India are found in?
A. Kashmir
B. Haryana
C. Himachal Pradesh
D. Gujarat
Ans. A Kashmir has a rate of gallstones of 9.6% of women and 3% of men.
Overall rate of gallstones in India - Men 2%, Women 5.6%.
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which of the following is not a mechanism for the formation of cholesterol gallstones ?
(Multiple options are correct)
A. Cholesterol Hypersecretion B. Alteration in intestinal bile salt/cholesterol absorption C. Gall Bladder Hypokinesia D. Bacterial Infection E. Increase in Bilirubin
Ans. D and E - Bacterial infection and increase in bilirubin play a role in formation of black or brown pigmented stones.
Cholesterol hypersecretion, alteration in intestinal bile salt/cholesterol absorption or gall bladder hypokinesia lead to cholesterol supersaturation and nucleation thus leading to formation of cholesterol gallstones.
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Which of the following statements is false?
A. incidence of gallstones becomes 4-10 times more in age>40 years.
B. prevalence of gallstones in children is 1.9%
C. American Indians (Pima) - upto 70% have gallstones <30 years of age due to high incidence of hemolytic anemia
D. in ages 0-18 years, nearly 40% cases of gallstones are due to hemolytic diseases.
Ans C. American Indians (Pima) have an increased incidence of gallstones (upto 70% by 30 years) however hereditary metabolic factors are implicated.
A, B and D are correct statements.
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which of the following is NOT TRUE regarding higher incidence of gallstones in women compared to men?
A. Estrogen decreases cholesterol secretion and increases bile salt excretion
B. Progestins cause stasis by decreasing gall bladder emptying.
C. Pregnancy is associated with upto 30% risk of developing biliary sludge
D. OCPs and Low Dose Estrogen therapy in post-menopausal wiomen also increases risk
Ans - A
The female gender is a risk factor for the development of gallstones as well as the chances of having surgery for gallstones by 2:1 to 3:1
Estrogen does increase the incidence but by increasing cholesterol secretion and decreasing bile salt excretion
B, C and D are true statements.
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which of the following is NOT TRUE regarding gallstones?
A. Obesity is a well established risk factor with 25% of morbidly obese having gallstones
B. associated with simple obesity in males and central obesity or metabolic syndrome in females
C. most of the cholesterol found in gallstones comes from the diet, thus high caloric and carbohydrate intake are risk factors
D. in the last 60 years the composition of stones has changed from pigmented to cholesterol.
Ans - B.
associated with simple obesity in females, and central obesity or metabolic syndrome in males.
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which of the following is NOT TRUE regarding gallstones and bariatric surgery?
A. Sludge and gallstones form in 30% to 70% patients after bariatric surgery
B. weight loss of less than 1.5 kg/week is a risk factor for stone formation or less than 25% of initial body weight loss.
C. gall stones are symptomatic in 7-16% of patients
D. stones usually become apparent 6 weeks after surgery
Ans B -
rapid weight loss is a risk factor and therefore weight loss more than 1.5 kg/week or more than 25% of initial body weight is a risk factor for the formation of stones.
A, C and D are correct statements.
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Which of the following is a FALSE statement
A. biliary sludge appears as early as 5-10 days after fasting
B. all patients develop stones after 6 weeks of TPN
C. sludge resolves within 4 weeks of cessation of TPN
D. none of the above
Ans B -
All patients develop SLUDGE after 6 weeks of TPN, whereas nearly 45% develop stones after 3 months of TPN.
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cirrhosis is a risk factor for the formation of what type of gall stones?
A. Brown Pigmented stones
B. Cholesterol stones
C. Black stones
D. none of the above
Ans C - Black Stones
cirrhosis is a risk factor for the formation of black stones with an overall prevalence of 25%-30%.
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Interference with bile salt resorption leading to gall stone formation is a mechanism in all of the following except -
A. Estrogen and Thiazide Diuretics
B. IBD
C. Ileal Resection
D. Cystic Fibrosis
Ans A -
Estrogen and Thiazide diuretics - increase biliary cholesterol secretion and thus lead to gallstone formation.
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Biliary pseudolithiasis and sludge is an adverse effect of
A. Ciprofloxacin
B. Metronidazole
C. Amoxycillin
D. Ceftriaxone
Ans D -
Ceftriaxone is excreted in bile in significant amounts and can cause biliary psuedolithiasis and sludge.
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